title: Clinical audit improves hypertension control in hemodialysis patients.
abstract: BACKGROUND
  In patients on hemodialysis (HD), hypertension is a risk factor for cardiovascular disease. In this study we tested the effectiveness of a clinical audit in improving blood pressure (BP) control in HD patients.
  
  
  METHODS
  177 adult, prevalent patients undergoing dialysis in NephroCare centers in Italy were audited. At the conclusion of the audit, individual strategies were developed in order to improve BP control. Patient data was collected and examined at months -1 (Pre), 0 (the date of the audit- Audit), and +1 and +6 after the audit (Post-1 and Post-6, respectively). We recorded BP, information on factors affecting BP, and anti-hypertensive drug regimen. The primary outcome of the study was to decrease prevalence of hypertension (BP ≥ 140/90 mmHg). Secondary outcomes were a reduction in average BP in hypertensive patients and/or a decrease in drug delivery associated with lower or unchanged BP.
  
  
  RESULTS
  104 patients out of 177 (58.7%) were hypertensive at Audit. BP levels were directly related to comorbidity and male sex, and inversely related to dialysate sodium concentration. The announcement of the audit alone was associated with a decreased prevalence of hypertension (Pre 64.4% to Audit 58.7%); a further decrease followed the audit (Post-1 51.1%, Post-6 47.6%, p<0.05 vs. Audit). Systolic BP in hypertensive patients also decreased (mean decrease was -8.5 and -14.1; p = 0.007 and p<0.001 at Post-1 and Post-6). Number of drugs assumed was significantly lower at Post-1 and Post-6 vs. Audit (p = 0.005 and p<0.001, respectively).
  
  
  CONCLUSIONS
  A clinical audit is an effective tool to improve BP control in HD patients.
authors.affiliation: Department of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy. pasqualeesposito@hotmail.com
authors.forename: Pasquale
authors.initials: P
authors.lastname: Esposito
authors.forename: Attilio Di
authors.initials: AD
authors.lastname: Benedetto
authors.forename: Carmine
authors.initials: C
authors.lastname: Tinelli
authors.forename: Annalisa
authors.initials: A
authors.lastname: De Silvestri
authors.forename: Teresa
authors.initials: T
authors.lastname: Rampino
authors.forename: Daniele
authors.initials: D
authors.lastname: Marcelli
authors.forename: Antonio
authors.initials: A
authors.lastname: Dal Canton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D015897:Comorbidity; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D007558:Italy / Q000453:epidemiology; D007674:Kidney Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D016014:Linear Models; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D015995:Prevalence; D058996:Quality Improvement; D006435:Renal Dialysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents