TY - JOUR
T1 - Considerable international variation exists in blood pressure control and antihypertensive prescription patterns in chronic kidney disease
AU - International Network of Chronic Kidney Disease cohort studies (iNET-CKD)
AU - Alencar de Pinho, Natalia
AU - Levin, Adeera
AU - Fukagawa, Masafumi
AU - Hoy, Wendy E
AU - Pecoits-Filho, Roberto
AU - Reichel, Helmut
AU - Robinson, Bruce
AU - Kitiyakara, Chagriya
AU - Wang, Jinwei
AU - Eckardt, Kai-Uwe
AU - Jha, Vivekanand
AU - Oh, Kook-Hwan
AU - Sola, Laura
AU - Eder, Susanne
AU - de Borst, Martin
AU - Taal, Maarten
AU - Feldman, Harold I
AU - Stengel, Bénédicte
N1 - Copyright © 2019 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.
PY - 2019/10
Y1 - 2019/10
N2 - Although blood pressure (BP) control is a major goal in chronic kidney disease (CKD), no worldwide overview of either its achievement or antihypertensive prescriptions is currently available. To evaluate this we compared crude prevalence of uncontrolled BP 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 BP of 140/90 mm Hg or more varied from 28% to 61% and of BP 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 (RAAS) 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 BP control among individuals with CKD. Thus, considerable heterogeneity in prescription patterns worldwide calls for further investigation into the impact of different approaches on patient outcomes.
AB - Although blood pressure (BP) control is a major goal in chronic kidney disease (CKD), no worldwide overview of either its achievement or antihypertensive prescriptions is currently available. To evaluate this we compared crude prevalence of uncontrolled BP 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 BP of 140/90 mm Hg or more varied from 28% to 61% and of BP 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 (RAAS) 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 BP control among individuals with CKD. Thus, considerable heterogeneity in prescription patterns worldwide calls for further investigation into the impact of different approaches on patient outcomes.
U2 - 10.1016/j.kint.2019.04.032
DO - 10.1016/j.kint.2019.04.032
M3 - Article
C2 - 31358344
SN - 0085-2538
VL - 96
SP - 983
EP - 994
JO - Kidney International
JF - Kidney International
IS - 4
ER -