title: Controlling systolic blood pressure is difficult in patients with diabetic kidney disease exhibiting moderate-to-severe reductions in renal function.
abstract: This study compared the use of antihypertensive treatment and blood pressure (BP) controls between patients with diabetic kidney disease (DK+) and patients with non-diabetic kidney disease (DK-) exhibiting moderate-to-severe chronic renal failure who did not need renal replacement therapy. A cross-sectional survey included all renal patients with s-creatinine at ?200 micromol/l attending regular control sessions at six renal units in Norway. Of the 351 patients included, 73 (20.8%) were DK+. The proportion reaching a BP goal of <130/80 mmHg was similar in DK+ and DK- (14.1% vs 13.6%, p = 0.92), while 38% and 39% achieved a BP of <140/90 mmHg, respectively. The systolic BP goal was more difficult to achieve than the diastolic BP goal in DK+ patients (35% vs 15%) despite a mean of three different types of drugs being used. Loop diuretics and beta-adrenergic-receptor antagonists were the most frequently prescribed drugs, and the use of angiotensin-converting enzyme inhibitors or angiotensin-II-receptor antagonists declined when renal function deteriorated, from 80% to 0% and from 66% to 20% in the DK+ and DK- groups, respectively (p = 0.001). Thus, despite the use of multiple antihypertensive drugs, controlling BP - especially the systolic BP - is difficult in high-risk patients with chronic renal failure caused by diabetic kidney disease.
authors.affiliation: Department of Pharmacotherapeutics, University of Oslo, Olso, Norway.
authors.forename: Marie Grøn
authors.initials: MG
authors.lastname: Saelen
authors.forename: Line Katrine
authors.initials: LK
authors.lastname: Prøsch
authors.forename: Helga
authors.initials: H
authors.lastname: Gudmundsdottir
authors.forename: Dagfinn
authors.initials: D
authors.lastname: Dyrbekk
authors.forename: Odd
authors.initials: O
authors.lastname: Helge Hunderi
authors.forename: Erik
authors.initials: E
authors.lastname: Arnesen
authors.forename: Dag
authors.initials: D
authors.lastname: Paulsen
authors.forename: Helge
authors.initials: H
authors.lastname: Skjønsberg
authors.forename: Ingrid
authors.initials: I
authors.lastname: Os
mesh_terms: D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology; D001795:Blood Pressure Determination; D003430:Cross-Sectional Studies; D003928:Diabetic Nephropathies / Q000188:drug therapy* / Q000503:physiopathology; D006306:Health Surveys; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000188:drug therapy* / Q000503:physiopathology; D008875:Middle Aged; D009664:Norway; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents