title: Blood pressure control in patients with chronic renal insufficiency in Spain: a cross-sectional study.
abstract: OBJECTIVE
  Despite therapeutic advances, strict control of hypertension remains elusive in patients with chronic renal insufficiency (CRI). The present study was designed for assessment of control rates of blood pressure in patients with CRI. Secondary objectives included evaluation of the control rates of proteinuria and cardiovascular comorbidities.
  
  
  METHODS
  A multicenter and cross-sectional survey of unselected patients with CRI attending outpatient nephrology clinics in Spain between April and September 2003 was performed.
  
  
  RESULTS
  Fifty-two centers recruited 2501 patients with a mean age 64.8 years (65.7% men). The prevalence of previous cardiovascular disease was 55%. The two most prevalent renal diseases were vascular (38.9%) and diabetic nephropathy (20.1%). Blood pressure below 130/80 mmHg was observed in 435 patients (17.4%). A poor blood pressure control was associated with older age, greater proteinuria and higher low-density lipoprotein cholesterol levels. Proteinuria less than 0.5 g/day was observed in 1209 cases (48.3%). A total of 1899 patients (75.9%) were receiving drugs suppressing the activity of the renin-angiotensin system and 1048 patients (41.9%) were being treated with three or more antihypertensive drugs. Lipid-lowering agents and antiplatelet therapy were used in 49.3 and 38.1% of patients, respectively.
  
  
  CONCLUSIONS
  The control rate of blood pressure in patients with CRI is inadequate despite frequent use of combination therapy that most commonly included an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Greater emphasis should be made to increase the number and dose of antihypertensive drugs and the need for using a statin as well as antiplatelet therapy in order to improve renal and cardiovascular outcomes.
authors.affiliation: Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain. rmarín@hca.es
authors.forename: Rafael
authors.initials: R
authors.lastname: Marín
authors.forename: Francisco
authors.initials: F
authors.lastname: Fernández-Vega
authors.forename: Manuel
authors.initials: M
authors.lastname: Gorostidi
authors.forename: Luis M
authors.initials: LM
authors.lastname: Ruilope
authors.forename: Javier
authors.initials: J
authors.lastname: Díez
authors.forename: Manuel
authors.initials: M
authors.lastname: Praga
authors.forename: Pablo
authors.initials: P
authors.lastname: Herrero
authors.forename: Jose M
authors.initials: JM
authors.lastname: Alcázar
authors.forename: Concepción
authors.initials: C
authors.lastname: Laviades
authors.forename: Pedro
authors.initials: P
authors.lastname: Aranda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000188:drug therapy; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology*
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors