Hypertension Management in Transition: From CKD to ESRD

Zinc Deficiency: A Potential Hidden Driver of the Detrimental Cycle of Chronic Kidney Disease and Hypertension

Globally, over 103 million individuals are afflicted by CKD, a silent killer claiming the lives of 1.2 million people annually. CKD is characterized by five progressive stages, in which dialysis and kidney transplant are life-saving routes for patients with end stage kidney failure. While kidney damage impairs kidney function and derails BP regulation, uncontrolled hypertension accelerates the development and progression of CKD. Zinc (Zn) deficiency has emerged as a potential hidden driver within this detrimental cycle of CKD and hypertension. This review article will (1) highlight mechanisms of Zn procurement and trafficking, (2) provide evidence that urinary Zn wasting can fuel Zn deficiency in CKD, (3) discuss how Zn deficiency can accelerate the progression of hypertension and kidney damage in CKD, and (4) consider Zn supplementation as an exit strategy with the potential to rectify the course of hypertension and CKD progression.

Antihypertensive therapy and adequacy of blood pressure control among adult hypertensive diabetic patients with chronic kidney disease in a tertiary referral hospital

Background: Tight blood pressure control retards the development of end-stage renal disease in hypertensive diabetic patients with chronic kidney disease. There is limited literature on blood pressure control among this patient population in a resource-limited setting. Research design and methods: A tertiary hospital-based cross-sectional study with 237 hypertensive diabetic patients with chronic kidney disease was conducted. A pre-tested questionnaire was used to assess patients' awareness of their ideal blood pressure. Data on blood pressure readings and antihypertensive therapies were abstracted into predesigned data collection forms and analyzed using STATA software version 13.0. Results: The participants' mean age was 61.8 ± 12.7 years and 106 (44.7%) patients were aware of the blood pressure targets. Adequate blood pressure control was found in 30.8%. Most (58.7%) were using ≥ 3 antihypertensive drug classes. Calcium channel blockers (51.1%), with principally amlodipine (26.2%) and nifedipine (24.1%), were the most preferred agents. Bivariate analysis showed enalapril (p = 0.009) and nifedipine (p = 0.022) being associated with adequate blood pressure control. However, nifedipine (AOR 2.79; 95% CI: 1.12-6.9, p = 0.028) and awareness of ideal blood pressure targets (AOR 4.57; 95% CI: 1.25-16.7, p = 0.022) were independent predictors of good control. Conclusion: Adequacy of blood pressure among hypertensive diabetic patients with chronic kidney disease is low and may be attributable to unawareness of its target level and using inappropriate therapy. Future studies should correlate level of blood pressure control with patient-, clinician-, and hospital-related factors.

The Comparison of Progressive Muscle Relaxation Frequency on Anxiety, Blood Pressure, and Pulse of Haemodialysis Patients

Introduction: Haemodialysis is one of the kidney replacements therapies, but, as it cannot wholly replace kidney function, it still causes complications such as increased blood pressure and pulse which can lead to anxiety for the patient. The purpose of this study was to explain the effect of Progressive Muscle Relaxation (PMR) on anxiety, blood pressure and pulse in haemodialysis patients.Methods: The study design was a true pre-post-test control group design experiment. The total sample was 105 haemodialysis patients taken by purposive sampling technique and divided into two intervention groups and one control group. The independent variable was PMR, and the dependent variables were anxiety, blood pressure and pulse. Data were obtained using a questionnaire and analysed using the Kruskal Wallis Test and Mann-Whitney U test with a significance level <0.05.Results: The results of the PMR two times per week group analysis for one month showed a significant influence on anxiety (p=0.000), blood pressure (p=0.000), and pulse rate (p=0.000). Mann-Whitney U Test Results showed a significant effect on anxiety (p=0.004), blood pressure (p=0.000), and pulse (p=0.000).Conclusion: Haemodialysis patients who performed PMR interventions showed a promising outcome on a decrease in anxiety, blood pressure and pulse. The regular application of PMR interventions can control vital signs in patients undergoing haemodialysis

Comorbidity Status and Annual Total Medical Expenditures in U.S. Hypertensive Adults

INTRODUCTION

The purpose of this study is to investigate comorbidity status and its impact on total medical expenditures in non-institutionalized hypertensive adults in the U.S.

METHODS

Data from the 2011-2014 Medical Expenditure Panel Survey were used. Patients were included if they had a diagnosis code for hypertension, were aged ≥18 years, and were not pregnant during the study period (N=26,049). The Elixhauser Comorbidity Index was modified to add hypertension-related comorbidities. The outcome variable was annual total medical expenditures, and a generalized linear model regression (gamma distribution with a log link function) was used. All costs were adjusted to 2014 U.S. dollars.

RESULTS

Based on the modified Elixhauser Comorbidity Index, 14.0% of patients did not have any comorbidities, 23.0% had one, 24.4% had two, and 38.7% had three or more. The five most frequent comorbidities were hyperlipidemia, diabetes, rheumatoid arthritis, depression, and chronic pulmonary disease. Estimated mean annual total medical expenditures were $3,914 (95% CI=$3,456, $4,372) for those without any comorbidity; $5,798 (95% CI=$5,384, $6,213) for those with one comorbidity; $8,333 (95% CI=$7,821, $8,844) for those with two comorbidities; and $13,920 (95% CI=$13,166, $14,674) for those with three or more comorbidities. Of the 15 most frequent comorbidities, the condition with the largest impact on expenditures for an individual person was congestive heart failure ($7,380). Hypertensive adults with stroke, coronary heart disease, diabetes, renal diseases, and hyperlipidemia had expenditures that were $6,069, $6,046, $5,039, $4,974, and $4,851 higher, respectively, than those without these conditions.

CONCLUSIONS

Comorbidities are highly prevalent among hypertensive adults, and this study shows that each comorbidity significantly increases annual total medical expenditures.