title: Blood pressure and antihypertensive medication profile in a multiethnic Asian population of stable chronic kidney disease patients.
abstract: BACKGROUND
  Clinical practice guidelines recommend different blood pressure (BP) goals for chronic kidney disease (CKD) patients. Usage of antihypertensive medication and attainment of BP targets in Asian CKD patients remain unclear. This study describes the profile of antihypertensive agents used and BP components in a multiethnic Asian population with stable CKD.
  
  
  METHODS
  Stable CKD outpatients with variability of serum creatinine levels < 20%, taken > 3 months apart, were recruited. Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured using automated manometers, according to practice guidelines. Serum creatinine was assayed and the estimated glomerular filtration rate (GFR) calculated using the CKD Epidemiology Collaboration equation. BP and antihypertensive medication profile was examined using univariate analyses.
  
  
  RESULTS
  613 patients (55.1% male; 74.7% Chinese, 6.4% Indian, 11.4% Malay; 35.7% diabetes mellitus) with a mean age of 57.8 ± 14.5 years were recruited. Mean SBP was 139 ± 20 mmHg, DBP was 74 ± 11 mmHg, serum creatinine was 166 ± 115 µmol/L and GFR was 53 ± 32 mL/min/1.73 m(2). At a lower GFR, SBP increased (p < 0.001), whereas DBP decreased (p = 0.0052). Mean SBP increased in tandem with the number of antihypertensive agents used (p < 0.001), while mean DBP decreased when ≥ 3 antihypertensive agents were used (p = 0.0020).
  
  
  CONCLUSIONS
  Different targets are recommended for each BP component in CKD patients. A majority of patients cannot attain SBP targets and/or exceed DBP targets. Research into monitoring and treatment methods is required to better define BP targets in CKD patients.
authors.affiliation: Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Boon Wee
authors.initials: BW
authors.lastname: Teo
authors.affiliation: Department of Medicine, National University Health System, Singapore.
authors.forename: Horng Ruey
authors.initials: HR
authors.lastname: Chua
authors.affiliation: Department of Medicine, National University Health System, Singapore.
authors.forename: Weng Kin
authors.initials: WK
authors.lastname: Wong
authors.affiliation: Department of Medicine, National University Health System, Singapore.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Haroon
authors.affiliation: Department of Medicine, National University Health System, Singapore.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Subramanian
authors.affiliation: Department of Medicine, National University Health System, Singapore.
authors.forename: Ping Tyug
authors.initials: PT
authors.lastname: Loh
authors.affiliation: Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Sunil
authors.initials: S
authors.lastname: Sethi
authors.affiliation: Department of Medicine, National University Health System, Singapore.
authors.forename: Titus
authors.initials: T
authors.lastname: Lau
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D044466:Asian People; D001794:Blood Pressure; D001795:Blood Pressure Determination; D003404:Creatinine / Q000097:blood; D003971:Diastole; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000208:ethnology*; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D017410:Practice Guidelines as Topic; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy* / Q000208:ethnology*; D012846:Singapore; D013223:Statistics as Topic; D013599:Systole
chemical_list: D000959:Antihypertensive Agents; D003404:Creatinine
keywords: Asian; blood pressure; chronic renal failure; hypertension; medication