Considerable international variation exists in blood pressure control and antihypertensive prescription patterns in chronic kidney disease

• Published in: Kidney International Vol. 96; no. 4; pp. 983 - 994
• Main Authors: Alencar de Pinho, Natalia, Levin, Adeera, Fukagawa, Masafumi, Hoy, Wendy E., Pecoits-Filho, Roberto, Reichel, Helmut, Robinson, Bruce, Kitiyakara, Chagriya, Wang, Jinwei, Eckardt, Kai-Uwe, Jha, Vivekanand, Oh, Kook-Hwan, Sola, Laura, Eder, Susanne, de Borst, Martin, Taal, Maarten, Feldman, Harold I., Stengel, Bénédicte, Djurdjev, Ognjenka, Tang, Mila, Fujii, Naohiki, Maruyama, Shoichi, Imaizumi, Takahiro, Zhang, Jianzhen, Wang, Zaimin, Healy, Helen G., Massy, Ziad A., Combe, Christian, Laville, Maurice, Filho, Roberto Pecoits, Lopes, Antonio, Pisoni, Ronald, Bieber, Brian, Tu, Charlotte, Sangthawan, Pornpen, Pichaiwong, Warangkana, Klyprayong, Pinkaew, Orlandi, Paula, Townsend, Raymond, Go, Alan, Zhang, Luxia, Kumar, Vivek, Yadav, Ashok Kumar, Baid-Agrawal, Seema, Ahn, Curie, Chae, Dong Wan, Han, Seung Hyeok, Rios, Pablo G., Gadola, Liliana, Lamadrid, Veronica, Leierer, Johannes, Kerschbaum, Julia, de Borst, Martin H., Van Ittersum, Frans J., Van den Brand, Jan A., De Jong, Maarten A., Taal, Maarten W., Shardlow, Adam
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2019; Elsevier BV; Nature Publishing Group
• Subjects: 2727 Nephrology; [SDV]Life Sciences [q-bio]; Adult; Adults; Aged; Aged, 80 and over; Antihypertensive Agents; antihypertensive treatment; Arterial-Hypertension; Asia; Association; Blood Pressure; chronic kidney disease; Clinical-Practice; Drug Prescriptions; Europe; Female; Glomerular Filtration Rate; Humans; Hypertension; hypertension control; India; international health; Life Sciences; Male; Management; Middle Aged; Mortality; Nephrology - Radboud University Medical Center; North America; Population; Practice Guidelines as Topic; Practice Patterns, Physicians; Prevalence; Radboudumc 11: Renal disorders RIHS: Radboud Institute for Health Sciences; Renal Insufficiency, Chronic; Renal Outcomes; Risk; Urology; Uruguay; chronic kidney disease; antihypertensive treatment; hypertension control; international health
• ISSN: 0085-2538; 1523-1755; 1523-1755
• DOI: 10.1016/j.kint.2019.04.032

Although blood pressure control is a major goal in chronic kidney disease, no worldwide overview of either its achievement or antihypertensive prescriptions is currently available. To evaluate this we compared crude prevalence of uncontrolled blood pressure 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 blood pressure of 140/90 mm Hg or more varied from 28% to 61% and of blood pressure 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 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 blood pressure control among individuals with chronic kidney disease. Thus, considerable heterogeneity in prescription patterns worldwide calls for further investigation into the impact of different approaches on patient outcomes. [Display omitted]