title: Improvement and influencing factors of blood pressure control by nephrologist referral in chronic kidney disease patients in China: a cohort study.
abstract: OBJECTIVE
  Hypertension is an independent risk factor for mortality in chronic kidney disease (CKD) and is suboptimally controlled worldwide. Therefore, this study aimed to examine the rate of BP control and the main barriers to achieving target BP, according to K/DOQI guidelines, in China.
  
  
  METHODS
  We performed a single-center, prospective cohort study. Two hundred and sixty CKD patients were referred by general physicians to nephrologists, and their BP was treated in accordance with K/DOQI guidelines for a 1-year follow-up. We evaluated improvement of BP target achievement and factors affecting BP control. We defined "not-at-goal" as persistence of systolic BP ≥ 130 mmHg and/or diastolic BP ≥ 80 mmHg after 1 year.
  
  
  RESULTS
  The BP decreased from 138 ± 12/84 ± 7 mmHg at baseline to 124 ± 13/73 ± 7 mmHg after 1 year. The rate of achieving the BP goal (<130/80 mmHg) increased from 25.4 to 61.5 %. The decrease in BP was associated with a significant reduction of proteinuria (median, 0.14 vs 0.06 g/24 h; P < 0.05). Logistic regression analysis identified proteinuria levels ≥1.0 g/24 h (odds ratio [OR]: 5.21; 95 % confidence interval [CI]: 1.37-19.77) and high basal systolic BP (OR: 2.17; 95 % CI: 1.25-3.77) and diastolic BP (OR: 6.62; 95 % CI: 2.03-21.60) as independent predictors of not-at-goal BP. Higher educational level was independently associated with at-goal BP (OR: 0.21; 95 % CI: 0.06-0.78).
  
  
  CONCLUSIONS
  In CKD patients, BP control is poor when managed by general physicians and may be improved after nephrologist referral. High basal BP and proteinuria levels ≥1.0 g/24 h are the main barriers that preclude the optimal control of BP.
authors.affiliation: Department of Nephrology, Affiliated Beijing Friendship Hospital, Faculty of Kidney Diseases, Capital Medical University, No. 95 Yong An Road, Xi Cheng District, Beijing, 100050, China.
authors.forename: Li-Yan
authors.initials: LY
authors.lastname: Wang
authors.forename: Dao-Xin
authors.initials: DX
authors.lastname: Yin
authors.forename: Dong-Liang
authors.initials: DL
authors.lastname: Zhang
authors.forename: Rui
authors.initials: R
authors.lastname: Xu
authors.forename: Wen-Ying
authors.initials: WY
authors.lastname: Cui
authors.forename: Wen-Hu
authors.initials: WH
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D002681:China; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009398:Nephrology; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011507:Proteinuria / Q000209:etiology / Q000652:urine*; D012017:Referral and Consultation; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000503:physiopathology*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents