title: Hypertension management in chronic kidney disease: translating guidelines into daily practice.
abstract: BACKGROUND
  Whether nephrology management improves over time achievement of blood pressure (BP) goal (<130/<80 mm Hg) in nondialysis CKD is still ill-defined. This historical cohort analysis evaluated the relationship between 1-year nephrology management and BP control in 275 incident CKD patients in an academic renal clinic.
  
  
  METHODS
  Comparative analysis between referral and month-12 visit.
  
  
  RESULTS
  Estimated glomerular filtration rate (GFR) was 42.1 ± 15.5 ml/min per 1.73 m2 and median proteinuria 0.20 g/24 hours. From baseline to month-12 visit, BP decreased from 148 ± 23 / 81 ± 12 mm Hg to 136 ± 18 / 76 ± 11 mm Hg, with BP goal prevalence increasing from 13.8% to 33.8%. We stratified patients into at-goal and not-at-goal on the basis of month-12 BP levels. Regression analysis identified diabetes (odds ratio [OR] = 1.96; 95% confidence interval [95% CI], 1.07-3.56) and basal systolic BP (OR=1.12; 95% CI, 1.03-1.21) as independent predictors of not-at-goal BP. The decrease in systolic/diastolic BP was smaller in not-at-goal versus at-goal patients (-7/3 mm Hg vs. -21/9 mm Hg); in not-at-goal reduction was, however, significant versus baseline (p<0.001) and coupled with a similar decline in proteinuria (p<0.001).
  
  
  CONCLUSIONS
  Sustained nephrology management improves hypertension control in CKD, but achievement of BP goals remains suboptimal, with high systolic BP and diabetes being the main problems. Further studies are needed to verify the clinical significance of BP and proteinuria changes in patients whose BP remains above target levels.
authors.affiliation: Division of Nephrology, Second University of Naples, Naples, Italy. luca.denicola@unina2.it
authors.forename: Luca
authors.initials: L
authors.lastname: De Nicola
authors.forename: Silvio
authors.initials: S
authors.lastname: Borrelli
authors.forename: Paolo
authors.initials: P
authors.lastname: Chiodini
authors.forename: Pasquale
authors.initials: P
authors.lastname: Zamboli
authors.forename: Carmela
authors.initials: C
authors.lastname: Iodice
authors.forename: Francis B
authors.initials: FB
authors.lastname: Gabbai
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Conte
authors.forename: Roberto
authors.initials: R
authors.lastname: Minutolo
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D002908:Chronic Disease; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000187:drug effects / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology*; D007674:Kidney Diseases / Q000453:epidemiology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012044:Regression Analysis; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents