J ZHANG1,2, Z WANG1,2, O ADEGBIJA1,2, R ABEYSEKERA1,3, HG HEALY1,3, KS TAN1,4 , SK VENUTHURUPALLI1,2,5 , A CAMERON1,2, WE HOY1,2
1NHMRC CKD.CRE and CKD.QLD, Brisbane, Queensland; 2Faculty of Medicine, UQCCR, University of Queensland, Brisbane, Queensland; 3Kidney Health Service (RBWH); Metro North Hospital and Health Service, Brisbane, Queensland; 4Renal Services (Logan), Metro South Hospital and Health Service, Brisbane, Queensland;5Renal Services (Toowoomba Hospital), Darling Downs Hospital and Health Service, Queensland
Aim: To describe rates of blood pressure control and associated factors, and medication use in hypertensive patients with non-dialysis chronic kidney disease (CKD) in selected Australian settings.
Background: Hypertension is the most significant risk factor for the development and progression of CKD. Lowering blood pressure is a major treatment goal.
Methods: In a collaborative study with the iNet-CKD consortium, we identified patients from three public renal practices in CKD.QLD, who had CKD stage 3A to 5, and had hypertension (a formal diagnosis and/or use of antihypertensive agents). We describe the proportions of controlled blood pressure (<140/90 mmHg), demographic and clinical characteristics and use of antihypertensive medications on recruitment to the registry.
Results: Of 1,750 participants, 61.7% had controlled blood pressure, and 95.7% were on antihypertensive medications with 23%, 29%, 27% and 17% on 1, 2, 3, and ≥4 classes of antihypertensive medications respectively. Treatment included renin-angiotensin system blockers in 71%. Patients on a single antihypertensive medication had the highest rates of hypertension control (67.7%). Hypertension was more often uncontrolled among people with mild and severe albuminuria/proteinuria with adjusted prevalence ratios of 1.27 (95%CI 1.06-1.52) and 1.61 (1.36-1.91) respectively, and in people who were older (≥65 years), 1.2(1.04-1.38). In contrast, people with cardiovascular disease (CVD) were less likely to have uncontrolled blood pressure: 0.77 (0.68-0.87). The associations with albuminuria/proteinuria and with age applied to most programs in iNet-CKD; and the CVD findings applied for the programs in Canada, the UK and Uruguay.
Conclusions: Despite the high usage of medication to treat hypertension in these CKD.QLD patients, the blood pressure goal was met on a single occasion in around 60%. Longitudinal data are needed for future study.