Current antihypertensive treatment and treatment-resistant hypertension in Japanese patients with chronic kidney disease
Current antihypertensive treatment and treatment-resistant hypertension in Japanese patients with chronic kidney disease
复制标题
DOI：
10.1007/s10157-022-02250-9
复制
发表时间：
2022-08
影响因子：
2.3
通讯作者：
A. Tsuchimoto;Shigeru Tanaka;H. Kitamura;H. Hiyamuta;K. Tsuruya;T. Kitazono;T. Nakano;Satoru Hideki Tadashi Tetsuhiko Takashi Koji Kiichiro Mas Fujimi Hirakata Hirano Yoshida Deguchi Mitsuiki Fu-Satoru-Hideki-Tadashi-Tetsuhiko-Takashi-Koji-Mas-Fu;S. Fujimi;H. Hirakata;T. Hirano;Tetsuhiko Yoshida;T. Deguchi;K. Mitsuiki;K. Fujisaki;M. Tokumoto;K. Nakai;A. Nagashima;R. Katafuchi;H. Kanai;Kenji Harada;T. Mizumasa;T. Ninomiya;K. Torisu;S. Yamada;D. Matsuo;Yusuke Kuroki;H. Nagae;M. Nakayama;M. Nagata;T. Yanagida;Shotaro Ohnaka
中科院分区：
文献类型：
--
作者：
A. Tsuchimoto;Shigeru Tanaka;H. Kitamura;H. Hiyamuta;K. Tsuruya;T. Kitazono;T. Nakano;Satoru Hideki Tadashi Tetsuhiko Takashi Koji Kiichiro Mas Fujimi Hirakata Hirano Yoshida Deguchi Mitsuiki Fu-Satoru-Hideki-Tadashi-Tetsuhiko-Takashi-Koji-Mas-Fu;S. Fujimi;H. Hirakata;T. Hirano;Tetsuhiko Yoshida;T. Deguchi;K. Mitsuiki;K. Fujisaki;M. Tokumoto;K. Nakai;A. Nagashima;R. Katafuchi;H. Kanai;Kenji Harada;T. Mizumasa;T. Ninomiya;K. Torisu;S. Yamada;D. Matsuo;Yusuke Kuroki;H. Nagae;M. Nakayama;M. Nagata;T. Yanagida;Shotaro Ohnaka
高血压是预测慢性肾脏疾病(CKD)患者预后的重要指标，推荐的目标血压一直在不断修订。本研究旨在揭示日本慢性肾脏病患者目前的降压措施。表观难治性高血压(ATRH)定义为血压控制失败，用三种降压药物或一种 ≥ 4种降压药物治疗而不考虑血压。血压控制符合KDIGO 2012指南推荐的目标血压。结果患者年龄中位数为67岁，体重指数(BMI)为23 mg/m2，估计肾小球滤过率(EGFR)为40 mg/min/1.73 m2。血压控制不佳的患者为1,933人，其中26%接受了 ≥ 3类降压药治疗。首选药物是肾素-血管紧张素系统抑制剂，其次是钙通道阻滞剂。CKD各期患者的噻嗪使用率均较低(3~11%)。ATRH的患病率为16%，与BMI(优势比[每1标准差变化的95%可信区间]1.38[1.25~1.53])、EGFR降低(1.87[1.57~2.23])以及年龄、糖尿病和慢性心脏病有关。即使在肾病医生的护理下，大多数患者也没有得到足够的抗高血压药物治疗。重要的是要开出足够种类的抗高血压药物，包括利尿剂，并改善患者的生活习惯。
BackgroundHypertension is an important prognostic predictor in patients with chronic kidney disease (CKD), and the recommended target blood pressure has been continuously revised. This study aimed to reveal the current antihypertensive practices in Japanese patients with CKD.MethodsIn the Fukuoka Kidney disease Registry, we extracted 3664 non-dialysis-dependent patients with CKD. Apparent treatment-resistant hypertension (aTRH) was defined as a failure of blood-pressure control treated with three antihypertensive medication classes or a treatment with ≥ 4 classes regardless of blood pressure. The blood-pressure control complied with the target blood pressure recommended by the KDIGO 2012 guideline.ResultsThe median age of the patients was 67 years, body mass index (BMI) was 23 kg/m2, and estimated glomerular filtration rate (eGFR) was 40 mL/min/1.73 m2. The number of patients with unachieved blood-pressure control was 1933, of whom 26% received ≥ 3 classes of antihypertensive medications. The first choice of medication was renin–angiotensin system inhibitors, followed by calcium-channel blockers. The rate of thiazide use was low in all CKD stages (3–11%). The prevalence of aTRH was 16%, which was significantly associated with BMI (odds ratio [95% confidence interval] per 1-standard deviation change, 1.38 [1.25–1.53]), decreased eGFR (1.87 [1.57–2.23]), as well as age, diabetes mellitus, and chronic heart disease.ConclusionsRenal dysfunction and obesity are important risk factors of aTRH. Even under nephrologist care, most patients were treated with insufficient antihypertensive medications. It is important to prescribe sufficient classes of antihypertensive medications, including diuretics, and to improve patients’ lifestyle habits.