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Titolo Hypertension management in chronic kidney disease: translating guidelines into daily practice
Autore Luca De Nicola 1, Silvio Borrelli 1, Paolo Chiodini 2, Pasquale Zamboli 1, Carmela Iodice 1, Francis B. Gabbai 3, Giuseppe Conte 1, Roberto Minutolo 1 - 1 Division of Nephrology, Second University of Naples, Naples - Italy 2 Department of Biostatistics, Second University of Naples, Naples - Italy 3 Division of Nephrology, University of California in San Diego, San Diego, California - USA
Referenza J NEPHROL 2011; DOI:10.5301/JN.2011.6335
Contenuto Background: Whether nephrology management improves over time achievement of blood pressure (BP) goal (<130/<80 mm Hg) in nondialysis CKD is still illdefined. This historical cohort analysis evaluated the relationship between 1-year nephrology management and BP control in 275 incident CKD patients in an academic renal clinic. Methods: Comparative analysis between referral and month-12 visit. Results: Estimated glomerular filtration rate (GFR) was 42.1 ± 15.5 ml/min per 1.73 m2 and median proteinuria 0.20 g/24 hours. From baseline to month-12 visit, BP decreased from 148 ± 23 / 81 ± 12 mm Hg to 136 ± 18 / 76 ± 11 mm Hg, with BP goal prevalence increasing from 13.8% to 33.8%. We stratified patients into at-goal and not-at-goal on the basis of month-12 BP levels. Regression analysis identified diabetes (odds ratio [OR] = 1.96; 95% confidence interval [95% CI], 1.07-3.56) and basal systolic BP (OR=1.12; 95% CI, 1.03-1.21) as independent predictors of not-at-goal BP. The decrease in systolic/diastolic BP was smaller in not-at-goal versus at-goal patients (-7/3 mm Hg vs. -21/9 mm Hg); in not-at-goal reduction was, however, significant versus baseline (p<0.001) and coupled with a similar decline in proteinuria (p<0.001). Conclusions: Sustained nephrology management improves hypertension control in CKD, but achievement of BP goals remains suboptimal, with high systolic BP and diabetes being the main problems. Further studies are needed to verify the clinical significance of BP and proteinuria changes in patients whose BP remains above target levels.
Data 17.11.2011
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