Antihypertensive therapy prescribing patterns and correlates of blood pressure control among hypertensive patients with chronic kidney disease

We used electronic health records (EHRs) data from 5658 ambulatory chronic kidney disease (CKD) patients with hypertension and prescribed antihypertensive therapy to examine antihypertensive drug prescribing patterns, blood pressure (BP) control, and risk factors for resistant hypertension (RHTN) in a real‐world setting. Two‐thirds of CKD patients and three‐fourths of those with proteinuria were prescribed guideline‐recommended renoprotective agents including an angiotensin‐converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB); however, one‐third were not prescribed an ACEI or ARB. CKD patients, particularly those with stages 1‐2 CKD, who were prescribed regimens including beta‐blocker (BB) + diuretic or ACEI/ARB + BB + diuretic were more likely to have controlled BP (<140/90 mm Hg) compared to those prescribed other combinations. Risk factors for RHTN included African American race and major comorbidities. Clinicians may use these findings to tailor antihypertensive therapy to the needs of each patient, including providing CKD stage‐specific treatment, and better identify CKD patients at risk of RHTN.

[1]  Jackson T. Wright,et al.  2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. , 2018, Journal of the American College of Cardiology.

[2]  Douglas E Schaubel,et al.  US Renal Data System 2017 Annual Data Report: Epidemiology of Kidney Disease in the United States. , 2018, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[3]  C. Gadegbeku,et al.  Hypertension in African Americans , 2017, Current Cardiology Reports.

[4]  Li-Chia Chen,et al.  Exploring factors associated with patients’ adherence to antihypertensive drugs among people with primary hypertension in the United Kingdom , 2017, Journal of hypertension.

[5]  P. Fadel,et al.  Sympathetic Overactivity in Chronic Kidney Disease: Consequences and Mechanisms , 2017, International journal of molecular sciences.

[6]  N. Samani,et al.  Risk Factors for Nonadherence to Antihypertensive Treatment , 2017, Hypertension.

[7]  A. Garg,et al.  Quality of Care for Patients With Chronic Kidney Disease in the Primary Care Setting: A Retrospective Cohort Study From Ontario, Canada , 2017, Canadian journal of kidney health and disease.

[8]  M. Fornage,et al.  Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association , 2017, Circulation.

[9]  V. Negri,et al.  Short-Term Local Adaptation of Historical Common Bean (Phaseolus vulgaris L.) Varieties and Implications for In Situ Management of Bean Diversity , 2017, International journal of molecular sciences.

[10]  B. Falkner,et al.  Hypertension in Chronic Kidney Disease. , 2016, Advances in experimental medicine and biology.

[11]  E. Argulian,et al.  Racial and Ethnic Differences in Antihypertensive Medication Use and Blood Pressure Control Among US Adults With Hypertension: The National Health and Nutrition Examination Survey, 2003 to 2012 , 2017, Circulation. Cardiovascular quality and outcomes.

[12]  C. McNaughton,et al.  Asymptomatic Elevated BP and the Hypertensive Insurgency , 2016, Current Hypertension Reports.

[13]  M. Stowasser,et al.  Resistant Hypertension and Chronic Kidney Disease: a Dangerous Liaison , 2016, Current Hypertension Reports.

[14]  Mahboob Rahman,et al.  Prevalence and Prognostic Significance of Apparent Treatment Resistant Hypertension in Chronic Kidney Disease: Report From the Chronic Renal Insufficiency Cohort Study , 2016, Hypertension.

[15]  M. Bots,et al.  Prevalence of Apparent Therapy-Resistant Hypertension and Its Effect on Outcome in Patients With Chronic Kidney Disease , 2015, Hypertension.

[16]  G. Bakris,et al.  The double challenge of resistant hypertension and chronic kidney disease , 2015, The Lancet.

[17]  N. Oestreicher,et al.  Evaluation of the treatment gap between clinical guidelines and the utilization of renin-angiotensin-aldosterone system inhibitors. , 2015, The American journal of managed care.

[18]  E. Lerma,et al.  Cardiovascular disease and chronic kidney disease. , 2015, Disease-a-month : DM.

[19]  R. Agarwal,et al.  Thiazide Diuretics in Chronic Kidney Disease , 2015, Current Hypertension Reports.

[20]  A. Bomback,et al.  Definition, identification and treatment of resistant hypertension in chronic kidney disease patients. , 2014, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[21]  Jackson T. Wright,et al.  2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). , 2014, JAMA.

[22]  C. van Weel,et al.  Effect of shared care on blood pressure in patients with chronic kidney disease: a cluster randomised controlled trial. , 2013, The British journal of general practice : the journal of the Royal College of General Practitioners.

[23]  S. Oparil,et al.  Prevalence of apparent treatment-resistant hypertension among individuals with CKD. , 2013, Clinical journal of the American Society of Nephrology : CJASN.

[24]  H. Tighiouart,et al.  Effects of intensive blood pressure lowering on the progression of chronic kidney disease: a systematic review and meta-analysis , 2013, Canadian Medical Association Journal.

[25]  R. Fluck,et al.  Suboptimal blood pressure control in chronic kidney disease stage 3: baseline data from a cohort study in primary care , 2013, BMC Family Practice.

[26]  R. Minutolo,et al.  Prevalence and prognostic role of resistant hypertension in chronic kidney disease patients. , 2013, Journal of the American College of Cardiology.

[27]  M. Ruzicka,et al.  Pharmacologic Treatment of Hypertension in Patients With Chronic Kidney Disease , 2013, American Journal of Cardiovascular Drugs.

[28]  A. Lasaridis,et al.  The effect of antihypertensive drugs on chronic kidney disease: a comprehensive review , 2013, Hypertension Research.

[29]  Brenda R. Hemmelgarn,et al.  Notice , 2012, Kidney International Supplements.

[30]  Li-yan Wang,et al.  Improvement and influencing factors of blood pressure control by nephrologist referral in chronic kidney disease patients in China: a cohort study , 2013, International Urology and Nephrology.

[31]  B. Altun,et al.  Major Barriers against Renin–Angiotensin–Aldosterone System Blocker Use in Chronic Kidney Disease Stages 3–5 in Clinical Practice: A Safety Concern? , 2012, Renal failure.

[32]  R. Agarwal,et al.  Thiazide diuretics in advanced chronic kidney disease. , 2012, Journal of the American Society of Hypertension : JASH.

[33]  M. Weir,et al.  Thiazide and Thiazide-like Diuretics: An Opportunity to Reduce Blood Pressure in Patients with Advanced Kidney Disease , 2012, Current Hypertension Reports.

[34]  L. Pilotto,et al.  Electronic records suggest suboptimal management of chronic kidney disease in general practice. , 2012, The Australian journal of rural health.

[35]  M. Raebel Hyperkalemia associated with use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. , 2012, Cardiovascular therapeutics.

[36]  Jackson T. Wright,et al.  Evidence-Based Guideline for the Management of High Blood Pressure in Adults , 2012 .

[37]  P. Zamboli,et al.  Burden of Resistant Hypertension in Hypertensive Patients with Non-Dialysis Chronic Kidney Disease , 2011, Kidney and Blood Pressure Research.

[38]  David W. Bates,et al.  Primary Care Management of Chronic Kidney Disease , 2011, Journal of General Internal Medicine.

[39]  M. Rolfe,et al.  Potassium homeostasis and renin-angiotensin-aldosterone system inhibitors. , 2010, Clinical journal of the American Society of Nephrology : CJASN.

[40]  D. Wheeler,et al.  Blood pressure control in CKD patients: why do we fail to implement the guidelines? , 2010, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[41]  Jackson T. Wright,et al.  ORIGINAL INVESTIGATIONS Pathogenesis and Treatment of Kidney Disease Hypertension Awareness, Treatment, and Control in Adults With CKD: Results From the Chronic Renal Insufficiency Cohort (CRIC) Study , 2010 .

[42]  D. Goff,et al.  Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. , 2008, Circulation.

[43]  Daniel W. Jones,et al.  The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. , 2003, JAMA.