Management And Control Of Hypertension In Hospitalized Patients With Chronic Kidney Disease

ObjectiveTo investigate management and control of hypertension in hospitalized patients with chronic kidney disease and hypertension, and to enrich data of this field and provide theoretical basis for better control of hypertension in patients with CKD.Methods726 patients with CKD and hypertension who hospitalized in our hospital from March 2009 to April 2010 were studied.Results91.9% patients were treated with antihypertensive medications,and 21.2%,22.6%,19.6%,28.4% took 1、2、3、≥4 antihypertensive medications, respectively.70.4% of those took 2 or more antihypertensive medications.CCB was the most frequently prescribed drug, taken by 68.2% patients, followed by renin-angiotensin system (RAS) inhibitors (55.6%,40.2% of the patients accepted ARB and 23.8% of patients accepted ACEI). The percentage of taking anti-hypertensive medications is similar in CKD 1-5 patients, but the proportion of combination therapy increased with the decline in renal function.Of patients with CKD and hypertension,42.4% had hypertension controlled to goal level, the mean systolic BP was (137.86±20.75)mmHg,whereas diastolic BP was (76.3±11.35)mmHg. However,64.1% patients receiving 3 or more antihypertensive drugs didn’t have hypertension controlled. Hypertension control rate decreased with the renal dysfunction in CKD1-5, with the rate of 53.1%、49.0%、47.7%、38.2%、33.9%, respectively. The hypertension control rate of dialysis patients (<140/90mm Hg) was significantly lower than that of non-dialysis of CKD1-5 (<130/80mm Hg) (33.5% vs 44.9%,P<0.05). There is no significant differences of hypertension control rate among three groups in ESRD, including non-dialysis group of CKD5, HD group and PD group (35.7%,32.3%, 38.7%, respectively, P>0.05). Control rate of hypertension in patients with Diabetes Mellitus is significantly lower than those without.Multivariate Logistic regression analysis showed that ACEI is a favorable factor for hypertension control (OR=2.415,95%CI 1.365-4.273, P=0.002).Pluse Pressure was associated with inadequate blood pressure control. Blood pressure control rate of each stratification in elderly patients was lower than those (18-39y) patients (P<0.001).Conclusions(1)The rate of treatment of hypertension in chronic kidney disease was high, with a high proportion of combination therapy. The combination of CCB and RAS inhibitors was the most frequently used in CKD patients. (2) The hypertension control rate is low, decreasing with the decline of renal function. It is similar between non-dialysis group in CKD5, HD group and PD group. (3) ACEI was a favorable factor of hypertension control, whereas age and pluse pressure was associated with suboptimal hypertension control.