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Optimal blood pressure for the prevention of hypertensive nephropathy in nondiabetic hypertensive patients in Taiwan.

ABSTRACT: Hypertension is a global health burden. However, clinical reference for the adequate management of blood pressure (BP) to prevent renal injury has yet to be established. Thus, this study aimed to investigate whether optimal control and maintenance of BP at < 140/90, < 130/80, or < 120/70 mmHg could prevent hypertensive nephropathy in nondiabetic hypertensive patients. A single-center observational study of 351 nondiabetic hypertensive patients was conducted in Taiwan. The average age of the participants was 64.0 years, and approximately 57.8% of the participants were men. Kidney function was assessed using estimated glomerular filtration rate (eGFR). The baseline eGFR was 83.8 ± 19.8 mL/min/1.73 m² . All patients were followed up every 3 months and underwent office BP measurement and blood sampling. Renal events were defined as> 25% and> 50% decline in eGFR. During an average follow-up period of 4.2 ± 2.3 years, a> 25% and> 50% decline in eGFR was noted in 49 and 11 patients, respectively. The Cox regression analysis revealed that a baseline BP ≥ 140/90 mmHg (hazard ratio [HR]: 1.965; 95% confidence interval [CI]: 1.099-3.514, P = 0.023) and ≥ 130/80 mmHg (HR: 2.799; 95% CI: 1.286-6.004, P = 0.009) increased the risk of> 25% decline in eGFR. Moreover, a baseline BP ≥ 140/90 mmHg (HR: 8.120; 95% CI: 1.650-39.956, P = 0.010) and follow-up BP ≥ 140/90 mmHg (HR: 6.402; 95% CI: 1.338-30.637, P = 0.020) increased the risk of> 50% decline in eGFR. In conclusion, a stringent baseline BP < 130/80 mmHg and a follow-up BP < 140/90 mmHg can be considered optimal cutoff values for clinical practice to prevent hypertensive nephropathy.

SUBMITTER: Kao TW

PROVIDER: S-EPMC8029863 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundThe rate of blood pressure control among hypertensive patients is poor and the reasons for poor control of blood pressure remain poorly understood globally.ObjectiveTo assess the rate of blood pressure control among adult hypertensive patients at Jimma University Specialized Hospital.Materials and methodsWe conducted a hospital based cross sectional study among adult hypertensive patients at Jimma University Specialized Hospital hypertension clinic from March 4, 2015 to April 3, 2015. Data on sociodemographic characteristics of the participants and adherence to antihypertensive medication(s) were collected from patients by face to face interview using a pretested structured questionnaire. Comorbidities, antihypertensive medication(s) and blood pressure measurements were collected retrospectively from medical records. Medication adherence was assessed using Morisky's Medication Adherence Scale-8 score. We did the statistical analysis using chi-square test and binary logistic regression with level of α set at 0.05. Statistical significance was considered for variables with p<0.05.ResultsOut of 311 participants, 286 patients were eligible and were studied. More than half, 154 (53.8%), of the participants were males. The mean age of the participants was 54.8± 12.6 years (range 26 to 94). The majority, 196 (68.53%), of the participants were taking more than one antihypertensive medication. More than one third (39.5%) of the participants were non adherent to their medication(s). The rate of blood pressure control was 50.3%. In a univariate logistic regression analyses, age ≥65 years old (P = 0.008), physical inactivity (p<0.001), chat chewing (P<0.001), adding salt to food (P<0.001), and coffee use (P<0.001) are significantly associated with uncontrolled blood pressure.ConclusionAlmost half of the hypertensive patients on follow up had uncontrolled blood pressure. We recommend better health education and care of patients to improve the rate of blood pressure control at the hospital.

Project description:BackgroundControlling blood pressure (BP) leads to significant reduction in cardiovascular risks and associated deaths. In Ethiopia, data is scarce about the level and determinants of optimal BP control among hypertensive patients. This study aimed to assess the prevalence and associated factors of optimal BP control among hypertensive patients attending at a district hospital.MethodsA hospital-based, cross-sectional study was conducted among 392 hypertensive patients who were on treatment and follow-up at a district hospital. A structured questionnaire adopted from WHO approach was prepared to collect the data. Medication adherence was measured by the four-item Morisky Green Levine Scale, with a score ≥3 defined as "good adherence". Blood pressure was measured, and optimal BP control was 0DEFined as systolic BP < 140 mmHg and diastolic BP<90 mmHg. Both binary and multivariable logistic regressions models were fitted to identify correlates of optimal BP control. All statistical tests were two-sided and a p values <0.05 was considered for statistical significance.ResultsThe mean age of the participants was 58 years (SD±13 years). Over half (53.8%) were females. Three quarters (77.3%) of the participants were adherent to their medications. The overall proportion of participants with optimally controlled BP was 42.9%.Female sex (Adjusted Odd Ratio(AOR) = 1.94, 95% CI: 1.15, 3.26), age older than 60 years (AOR = 2.95, 95% CI: 1.18, 7.40), consumption of vegetables on most days of the week (AOR = 2.16, 95% CI: 1.25, 3.73), physical activity (AOR = 4.85, 95% CI: 2.39, 9.83), and taking less than three drugs per day (AOR = 3.04, 95% CI: 1.51, 6.14) were positively associated with optimally controlled BP. Poor adherence to medications (AOR = 0.18, 95% CI: 0.09, 0.35), having asthma comorbidity (AOR = 0.33, 95% CI:0.12, 0.88) and use of top added salt on a plate (AOR = 0.20, 95% CI:0.11, 0.36) were negatively associated with optimal BP control.ConclusionA higher proportion of hypertensive patients remain with un-controlled BP. Modifiable risk factors including poor adherence to medications, lack of physical exercise, adding salt into meals, being on multiple medications and comorbidities were significantly and independently associated with poor BP control. Evidence-based, adherence-enhancing and healthy life style interventions should be implemented.

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Optimal blood pressure for the prevention of hypertensive nephropathy in nondiabetic hypertensive patients in Taiwan.

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