Improvement of Blood Pressure Control in Hypertensive Patients with Renal Diseases

295 Hypertens Res Vol.30 (2007) No.4 p.295-300 Original Article Improvement of Blood Pressure Control in Hypertensive Patients with Renal Diseases Yuko OHTA1), Kazuhiko TSURUYA1), Koji FUJII1), Masanori TOKUMOTO1), Hidetoshi KANAI1), Kiyoshi MATSUMURA1), Takuya TSUCHIHASHI1), Hideki HIRAKATA1), and Mitsuo IIDA1) For hypertensive patients with renal diseases (RD), strict blood pressure (BP) control has been recommended in recent hypertension guidelines, such as JNC VI, JNC 7, WHO/ISH 1999 and ESH-ESC 2003. We assessed the current status of BP control and the changes of BP control before and after the publication of these guidelines in 489 hypertensive patients with or without RD (age, 19–89 years, mean 59 ± 13 years) who visited the hypertension and kidney outpatient clinic at Kyushu University Hospital. The clinical characteristics of RD and non-RD patients were assessed (RD patients: age, 20–89 years, mean 60 ± 13 years, n = 311; non-RD patients: age, 19–86 years, mean 58 ± 13 years, n = 178). In addition, we compared the BP control status in 2003 to that in 1996. In 2003, the BP in RD patients was 134 ± 16/78 ± 10 mmHg and that in non-RD patients was 138 ± 12/83 ± 9 mmHg. When strict BP control was defined as < 130/80 mmHg, the frequency of strict BP control in RD patients was 28.9% in 2003. In addition, the BP levels of RD patients in 2003 were significantly lower than those in 1996 (134 ± 16/78 ± 10 mmHg vs. 141 ± 17/85 ± 10 mmHg, p < 0.05 for both systolic blood pressure [SBP] and diastolic blood pressure [DBP]), and the frequency of strict BP control in RD patients was higher in 2003 than in 1996 (28.9% vs. 11.8%, p < 0.01). The BP levels of non-RD patients in 2003 tended to be lower than those in 1996 (138 ± 12/83 ± 9 mmHg vs. 141 ± 13/85 ± 9 mmHg, n.s.). In 2003, angiotensin II receptor blockers (ARBs) were more frequently prescribed to RD patients than to nonRD patients. Furthermore, the use of ARBs was markedly increased in 2003 compared with 1996. In conclusion, in our outpatient clinic, BP levels in hypertensive patients with RD have improved in recent years, and were lower than those in hypertensive patients without RD, which may in part reflect the physicians’ awareness of the importance of strict BP control in RD patients, as suggested by several recent hypertension guidelines. (Hypertens Res 2007; 30: 295–300) Key Words: blood pressure control, new guidelines, renal diseases, angiotensin II receptor blockers, physicians’ awareness Introduction Hypertension is considered to be a cause as well as a complication of chronic kidney disease (1). Hypertension in chronic kidney disease increases the risk of serious adverse outcomes, including renal failure, early development and accelerated progression of cardiovascular disease, and premature death (1–3). A number of randomized controlled trials have shown that antihypertensive treatment reduces cardiovascular mortality and morbidity and slows the progression of renal diseases (RD) (4–6). Furthermore, there is evidence that the benefit achieved is related to the extent to which blood pressure (BP) is lowered (1, 4–7). Based on the findings obtained from the large-scale clinical trials (5, 7), recent guidelines for the management of hypertension, such as JNC VI, JNC 7, From the 1)Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. Address for Reprints: Yuko Ohta, M.D., Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3–1–1, Higashi-ku, Fukuoka 812–8582, Japan. E-mail: Received February 21, 2006; Accepted in revised form December 12, 2006. 296 Hypertens Res Vol. 30, No. 4 (2007) Table 1. Trends in Characteristics of Hypertensive Patients with (RD) and without Renal Diseases (Non-RD) in 1996 and 2003 All Number of patients Age (years) Male (%) Systolic blood pressure (mmHg) Diastolic blood pressure (mmHg) Pulse pressure (mmHg) Pulse (/min) Serum urea nitrogen (mg/dl) Glomerular filtration ratio (ml/min) Prevalence of diabetes mellitus (%) Prevalence of hyperlipidemia (%) RD Non-RD 1996 2003 1996 2003 1996 2003 469 56±13 49.2 141±16 85±10 56±16 71±10 21±14 68±34 13.0 56.9 489 59±13†† 48.5 135±15†† 80±10†† 55±4 73±10† 21±14 66±32 10.8† 49.9† 323 56±13 52.0* 141±17 85±10 56±17 72±10* 24±16* 56±33* 9.3** 57.3 311 60±13† 50.8 134±16† 78±10†,* 56±5 72±9 25±16* 53±29* 10.6 50.5 146 56±12 41.8 141±13 85±9 56±13 69±10 14±4 92±22 21.2 54.8 178 58±13 44.4 138±12 83±9 54±3 74±11† 14±4 90±19 11.2† 48.9 Values are means±SD. †p<0.05, ††p<0.01 vs. 1996 of the corresponding group, *p<0.05, **p<0.01 vs. non-RD of the same year. All hypertensive 1996 RD 11.3% 62.0% 26.7% non-RD 10.3% 11.8% 63.2% 25.1% 59.6% 30.1% 2003 23.1% 43.1% 33.8% 12.9% 28.9% 37.3% 53.4% 33.7% 33.8% p<0.01 vs. non-RD of the same year p <0.05 , p<0.01 v s. 1996 of the corresponding group Fig. 1. The status of BP control in patients with (RD) and without renal diseases (non-RD) in 1996 and 2003. WHO/ISH 1999, ESH-ESC 2003 and Japanese Society of Hypertension (JSH) 2004 recommend strict BP control in RD (8–11). Moreover, the development of newer classes of antihypertensive drugs, such as angiotensin II receptor blockers (ARBs), has had a beneficial influence on the management of hypertension with RD (2, 3, 12–25). Thus, the aim of the present study was to assess the current status of BP control in hypertensive patients with RD, and whether BP control improved during the period between 1996 and 2003, i.e., before and after the introduction of recent hypertension guidelines. Methods We investigated 489 hypertensive patients with or without RD who had been followed at the hypertension and kidney outpatient clinic of Kyushu University Hospital in 2003, as well as 469 hypertensive patients in 1996; many patients from the 1996 group were also included in the 2003 group. The BP levels and other clinical characteristics were compared between the RD and non-RD patients. We also compared numerous clinical characteristics including sex, age, presence of diabetes mellitus (DM), presence of hyperlipidemia, and antihypertensive regimens between the patients in 1996 and Ohta et al: Blood Pressure Control in Renal Diseases All hypertensive 1996 RD non-RD 3.2% 3.7% 2.1% 12.8% 11.3% 14.6% 12.7% 8.9% 8.2% 38.0% 34.7% 2003 15.1% 36.8% 32.2% 0 12.9% 7.9% 2 16.5% 31.5% 31.9% 40.5% 40.4% 1 6.4% 7.0% 40.4% 3.9% 6.4% 5.5% 297 32.6% 42.7% 39.2% p<0.05, 3 4 p < 0.01 vs. 1996 o f the corresponding group Fig. 2. The number of antihypertensive drugs used in RD and non-RD patients in 1996 and 2003. those in 2003. Hypertension was defined as systolic blood pressure (SBP) ≥ 140 mmHg and/or diastolic blood pressure (DBP) ≥ 90 mmHg or the current use of antihypertensive drugs. In RD patients on antihypertensive treatment, we also checked the previous clinical records of each patient in order (...truncated)