Insufficient therapeutic management of hypertensive patients with renal failure in France.
BACKGROUND
Hypertension is both the cause and consequence of chronic renal failure (CRF). The prevalence of CRF, which itself is a cardiovascular risk factor, is not well known in France.


OBJECTIVE
To estimate the prevalence of renal dysfunction among hypertensive patients who were seen by general practitioners (GP); to assess the drug management of hypertension in these patients according to their renal status.


METHODS
A transversal observational study among patients of both genders aged 18 or more, with arterial blood pressure greater than 130/80 mmHg (i.e., over CRF-recommended blood pressure) or under antihypertensive drugs who were recruited in France by GP.


RESULTS
Among the 2315 included patients, 1908 could be analyzed for their renal function. Of these, 70.5% had an estimated glomerular filtration rate (GFR) of 89 ml/min per 1.73 m(2) or lower. One third of these patients (31.4%) were suffering from renal failure (GFR<or=59 ml/min per 1.73 m(2)). CRF was moderate in 27.9% of patients, severe in 2.20% and terminal (GFR<15 ml/min per 1.73 m(2)) in 1.26%. At least one antihypertensive drug was taken by 1952 patients (84.3%), regardless of the patient's renal status.


CONCLUSIONS
Hypertensive patients who are seen by GP have a high level of renal disturbances and many of them do not reach recommended blood pressure values. This highlights the importance of an early detection of renal dysfunction avoiding progression towards end-stage renal failure and an adapted antihypertensive drugs prescription, such as angiotensin-converting enzyme inhibitors and angiotensin receptor blocker, acting as renal protectors.
P-Guérin
Alain
A
Service de néphrologie, centre hospitalier Manhès, 8, Grande-Rue, 91700 Fleury-Mérogis, France. alguerin@club-internet.fr
Maumus-Robert
Sandy
S
Zin
Adeline
A
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D003404:Creatinine / Q000097:blood; D003695:Delivery of Health Care; D018450:Disease Progression; D005194:Family Practice; D005260:Female; D005602:France; D005919:Glomerular Filtration Rate; D019538:Health Care Surveys; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D012042:Registries; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D003404:Creatinine