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Considerable international variation exists in blood pressure control and antihypertensive prescription patterns in chronic kidney disease

Alencar de Pinho, Natalia; Levin, Adeera; Fukagawa, Masafumi; Hoy, Wendy E; Pecoits-Filho, Roberto; Reichel, Helmut; Robinson, Bruce; Kitiyakara, Chagriya; Wang, Jinwei; Eckardt, Kai-Uwe; Jha, Vivekanand; Oh, Kook-Hwan; Sola, Laura; Eder, Susanne; de Borst, Martin; Taal, Maarten; Feldman, Harold I.; Stengel, Bénédicte

Authors

Natalia Alencar de Pinho

Adeera Levin

Masafumi Fukagawa

Wendy E Hoy

Roberto Pecoits-Filho

Helmut Reichel

Bruce Robinson

Chagriya Kitiyakara

Jinwei Wang

Kai-Uwe Eckardt

Vivekanand Jha

Kook-Hwan Oh

Laura Sola

Susanne Eder

Martin de Borst

Harold I. Feldman

Bénédicte Stengel



Abstract

Although blood pressure control is a major goal in chronic kidney disease, no worldwide overview of either its achievement or antihypertensive prescriptions is currently available. To evaluate this we compared crude prevalence of uncontrolled blood pressure among 17 cohort studies, including 34 602 individuals with estimated glomerular filtration rate under 60 ml/min/1.73 m2 and treated hypertension across four continents, and estimated observed to expected prevalence ratios, adjusted for potential confounders. Crude prevalence of blood pressure of 140/90 mm Hg or more varied from 28% to 61% and of blood pressure of 130/80 or more from 54% to 84%. Adjusted prevalence ratios indicated poorer hypertension control than expected in cohorts from European countries, India, and Uruguay, and better control in patients from North American and high-income Asian countries. Four antihypertensive drug classes or more were prescribed to more than 30% of participants in North American and some European cohorts, but this practice was less common elsewhere. Renin angiotensin-aldosterone system inhibitors were the most common antihypertensive drugs, prescribed for 54% to 91% of cohort participants. Differences for other drug classes were much stronger, ranging from 11% to 79% for diuretics, 22% to 70% for beta-blockers, and 27% to 75% for calcium-channel blockers. The confounders studied explain only a part of the international variation in blood pressure control among individuals with chronic kidney disease. Thus, considerable heterogeneity in prescription patterns worldwide calls for further investigation into the impact of different approaches on patient outcomes.

Journal Article Type Article
Publication Date 2019-10
Journal Kidney International
Print ISSN 0085-2538
Electronic ISSN 1523-1755
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 96
Issue 4
Pages 983-994
APA6 Citation Alencar de Pinho, N., Levin, A., Fukagawa, M., Hoy, W. E., Pecoits-Filho, R., Reichel, H., …Stengel, B. (2019). Considerable international variation exists in blood pressure control and antihypertensive prescription patterns in chronic kidney disease. Kidney International, 96(4), 983-994. https://doi.org/10.1016/j.kint.2019.04.032
DOI https://doi.org/10.1016/j.kint.2019.04.032
Keywords CESP; INSERM U1018; Renal and Cardiovascular Epidemiology Team Subject Area: Clinical Nephrology; Epidemiology and Statistics; Hypertension Keywords: chronic kidney disease; ACE Inhibitors; cardiovascular disease; diuretics
Publisher URL https://www.sciencedirect.com/science/article/pii/S0085253819305125?via%3Dihub

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