1
|
Nagaraju SP, Shenoy SV, Rao IR, Bhojaraja MV, Rangaswamy D, Prabhu RA. Measurement of Blood Pressure in Chronic Kidney Disease: Time to Change Our Clinical Practice - A Comprehensive Review. Int J Nephrol Renovasc Dis 2022; 15:1-16. [PMID: 35177924 PMCID: PMC8843793 DOI: 10.2147/ijnrd.s343582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/31/2021] [Indexed: 11/24/2022] Open
Abstract
Chronic kidney disease (CKD) is extremely common all over the world and is strongly linked to cardiovascular disease (CVD). The great majority of CKD patients have hypertension, which raises the risk of cardiovascular disease (CVD), end-stage kidney disease, and mortality. Controlling hypertension in patients with CKD is critical in our clinical practice since it slows the course of the disease and lowers the risk of CVD. As a result, accurate blood pressure (BP) monitoring is crucial for CKD diagnosis and therapy. Three important guidelines on BP thresholds and targets for antihypertensive medication therapy have been published in the recent decade emphasizing the way we measure BP. For both office BP and out-of-office BP measuring techniques, their clinical importance in the management of hypertension has been well defined. Although BP measurement is widely disseminated and routinely performed in most clinical settings, it remains unstandardized, and practitioners frequently fail to follow the basic recommendations to avoid measurement errors. This may lead to misdiagnosis and wrong management of hypertension, especially in CKD patients. Here, we review presently available all BP measuring techniques and their use in clinical practice and the recommendations from various guidelines and research gaps emphasizing CKD patients.
Collapse
Affiliation(s)
- Shankar Prasad Nagaraju
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, 576104, India
| | - Srinivas Vinayak Shenoy
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, 576104, India
| | - Indu Ramachandra Rao
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, 576104, India
| | - Mohan V Bhojaraja
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, 576104, India
- Correspondence: Mohan V Bhojaraja, Email
| | - Dharshan Rangaswamy
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, 576104, India
| | - Ravindra Attur Prabhu
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, 576104, India
| |
Collapse
|
2
|
Jahromi SE, Haghighi G, Roozbeh J, Ebrahimi V. Comparisons between different blood pressure measurement techniques in patients with chronic kidney disease. Kidney Res Clin Pract 2019; 38:212-219. [PMID: 30970391 PMCID: PMC6577220 DOI: 10.23876/j.krcp.18.0109] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 02/07/2019] [Accepted: 02/23/2019] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Automated office blood pressure (AOBP) machines measure blood pressure (BP) multiple times over a brief period. We aimed to compare the results of manual office blood pressure (MOBP) and AOBP methods with ambulatory BP monitoring (ABPM) in patients with chronic kidney disease (CKD). METHODS This study was performed on 64 patients with CKD (stages 3-4). A nurse manually measured the BP on both arms using a mercury sphygmomanometer, followed by AOBP of the arm with the higher BP and then ABPM. Mean BP readings were compared by paired t test and Bland-Altman graphs. RESULTS The mean ± standard deviation (SD) age of participants was 59.3 ± 13.6. The mean ± SD awake systolic BP obtained by ABPM was 140.2 ± 19.0 mmHg, which was lower than the MOBP and AOBP methods (156.6 ± 17.8 and 148.8 ± 18.6 mmHg, respectively; P < 0.001). The mean ± SD awake diastolic BP was 78.6 ± 13.2 mmHg by ABPM which was lower than the MOBP and AOBP methods (88.9 ± 13.2 and 84.1 ± 14.0 mmHg, respectively; P < 0.001). Using Bland-Altman graphs, MOBP systolic BP readings showed a bias of 16.4 mmHg, while AOBP measurements indicated a bias of 8.6 mmHg compared with ABPM. CONCLUSION AOBP methods may be more reliable than MOBP methods for determining BP in patients with CKD. However, the significantly higher mean BPs recorded by AOBP method suggested that AOBPs may not be as accurate as ABPM in patients with CKD.
Collapse
Affiliation(s)
| | - Ghasem Haghighi
- Department of Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz,
Iran
| | - Jamshid Roozbeh
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz,
Iran
| | - Vahid Ebrahimi
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz,
Iran
- Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz,
Iran
- Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz,
Iran
| |
Collapse
|
3
|
Magvanjav O, Cooper‐DeHoff RM, McDonough CW, Gong Y, Segal MS, Hogan WR, Johnson JA. Antihypertensive therapy prescribing patterns and correlates of blood pressure control among hypertensive patients with chronic kidney disease. J Clin Hypertens (Greenwich) 2019; 21:91-101. [PMID: 30427124 PMCID: PMC6329007 DOI: 10.1111/jch.13429] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/27/2018] [Accepted: 09/07/2018] [Indexed: 02/06/2023]
Abstract
We used electronic health records (EHRs) data from 5658 ambulatory chronic kidney disease (CKD) patients with hypertension and prescribed antihypertensive therapy to examine antihypertensive drug prescribing patterns, blood pressure (BP) control, and risk factors for resistant hypertension (RHTN) in a real-world setting. Two-thirds of CKD patients and three-fourths of those with proteinuria were prescribed guideline-recommended renoprotective agents including an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB); however, one-third were not prescribed an ACEI or ARB. CKD patients, particularly those with stages 1-2 CKD, who were prescribed regimens including beta-blocker (BB) + diuretic or ACEI/ARB + BB + diuretic were more likely to have controlled BP (<140/90 mm Hg) compared to those prescribed other combinations. Risk factors for RHTN included African American race and major comorbidities. Clinicians may use these findings to tailor antihypertensive therapy to the needs of each patient, including providing CKD stage-specific treatment, and better identify CKD patients at risk of RHTN.
Collapse
Affiliation(s)
- Oyunbileg Magvanjav
- Department of Pharmacotherapy and Translational ResearchUniversity of Florida College of PharmacyGainesvilleFlorida
| | - Rhonda M. Cooper‐DeHoff
- Department of Pharmacotherapy and Translational ResearchUniversity of Florida College of PharmacyGainesvilleFlorida
- Division of Cardiovascular Medicine, Department of MedicineUniversity of Florida College of MedicineGainesvilleFlorida
| | - Caitrin W. McDonough
- Department of Pharmacotherapy and Translational ResearchUniversity of Florida College of PharmacyGainesvilleFlorida
| | - Yan Gong
- Department of Pharmacotherapy and Translational ResearchUniversity of Florida College of PharmacyGainesvilleFlorida
| | - Mark S. Segal
- Division of Nephrology, Hypertension and Renal Transplant, Department of MedicineUniversity of Florida, and North Florida/South Georgia Veterans Health SystemGainesvilleFlorida
| | - William R. Hogan
- Department of Health Outcomes and Biomedical InformaticsUniversity of Florida College of MedicineGainesvilleFlorida
| | - Julie A. Johnson
- Department of Pharmacotherapy and Translational ResearchUniversity of Florida College of PharmacyGainesvilleFlorida
- Division of Cardiovascular Medicine, Department of MedicineUniversity of Florida College of MedicineGainesvilleFlorida
| |
Collapse
|
4
|
Ali A, Abu Zar M, Kamal A, Faquih AE, Bhan C, Iftikhar W, Malik MB, Ahmad MQ, Ali NS, Sami SA, Jitidhar F, Cheema AM, Zulfiqar A. American Heart Association High Blood Pressure Protocol 2017: A Literature Review. Cureus 2018; 10:e3230. [PMID: 30410836 PMCID: PMC6207493 DOI: 10.7759/cureus.3230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Hypertension is the most prevalent clinical symptom arising from various cardiovascular disorders. Likewise, it is considered a precursor or sequelae to the development of acute coronary artery disease and congestive heath failure (CHF). Hypertension has been considered a cardinal criterion to determine cardiovascular function. According to the World Health Organization (WHO) global observatory data, hypertension causes more than 7.5 million deaths a year, about 12.8% of the total human mortality. Similarly, the Center for Disease Control (CDC) states that 35% of the American adults have been estimated to have a persistently high blood pressure, which makes it about one in every three adults. Hypertension is a modifiable symptom that can be managed through pharmacological and non-pharmacological methods and standard protocols set forth by the American Heart Association (AHA). With new findings from various clinical trials related to the management of hypertension, new developments and recommendations have been made to update the previously established protocols for hypertension. This article aims to discuss and dissect the modern updates of hypertension management as comprehensively elaborated in the 2017 Hypertension Clinical Practice Guidelines.
Collapse
Affiliation(s)
- Asad Ali
- Medicine, CMH Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | | | - Ahmad Kamal
- Hematology and Oncology, The University of Arizona, Tucson, USA
| | - Amber E Faquih
- Graduate, Dow University of Health Sciences, Karachi, PAK
| | - Chandur Bhan
- Internal Medicine, Chandka Medical College Hospital, Larkana, PAK
| | - Waleed Iftikhar
- Internal Medicine, CMH Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | | | | | | | - Shahzad Ahmed Sami
- Internal Medicine, CMH Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Fnu Jitidhar
- Internal Medicine, Orthopedic and Medical Institute, Karachi, PAK
| | - Abbas M Cheema
- Internal Medicine, Combined Military Hospital, Lahore, PAK
| | - Annum Zulfiqar
- Internal Medicine, Sheikh Zayed Medical College/Hospital, Lahore, PAK
| |
Collapse
|
5
|
Mancusi C, Izzo R, de Simone G, Carlino MV, Canciello G, Stabile E, de Luca N, Trimarco B, Losi MA. Determinants of decline of renal function in treated hypertensive patients: the Campania Salute Network. Nephrol Dial Transplant 2018; 33:435-440. [DOI: 10.1093/ndt/gfx062] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
- Costantino Mancusi
- Hypertension Research Center, University of Naples, Federico II, Naples, Italy
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Raffaele Izzo
- Hypertension Research Center, University of Naples, Federico II, Naples, Italy
- Department of Translational Medical Sciences, University of Naples, Federico II, Naples, Italy
| | - Giovanni de Simone
- Hypertension Research Center, University of Naples, Federico II, Naples, Italy
- Department of Translational Medical Sciences, University of Naples, Federico II, Naples, Italy
| | - Maria Viviana Carlino
- Hypertension Research Center, University of Naples, Federico II, Naples, Italy
- Department of Translational Medical Sciences, University of Naples, Federico II, Naples, Italy
| | - Grazia Canciello
- Hypertension Research Center, University of Naples, Federico II, Naples, Italy
- Department of Translational Medical Sciences, University of Naples, Federico II, Naples, Italy
| | - Eugenio Stabile
- Hypertension Research Center, University of Naples, Federico II, Naples, Italy
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Nicola de Luca
- Hypertension Research Center, University of Naples, Federico II, Naples, Italy
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Bruno Trimarco
- Hypertension Research Center, University of Naples, Federico II, Naples, Italy
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Maria Angela Losi
- Hypertension Research Center, University of Naples, Federico II, Naples, Italy
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| |
Collapse
|
6
|
Abstract
PURPOSE OF REVIEW Emerging evidence suggests that multiple mechanisms may be responsible for the development of treatment-resistant hypertension (TRH). This review aims to summarize recent data on potential mechanisms of resistance and discuss current pharmacotherapeutic options available in the management of TRH. RECENT FINDINGS Excess sodium and fluid retention, increased activation of the renin-angiotensin-aldosterone system, and heightened activity of the sympathetic nervous system appear to play an important role in development of TRH. Emerging evidence also suggests a role for arterial stiffness and, potentially, gut dysbiosis. Therapeutic approaches for TRH should include diuretic optimization and the addition of aldosterone antagonists as the preferred fourth agent in most patients. Further therapeutic approaches may be guided by the suspected underlying mechanism of TRH in conjunction with other patient-specific factors. The pathophysiology of TRH is multifaceted; however, increasing evidence supports several mechanisms that may be targeted to improve blood pressure control among patients with TRH. Further studies are needed to determine whether such approaches may be more effective than usual care.
Collapse
|
7
|
Wakino S. [The clinical characteristics of hypertension in chronic kidney disease.]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2016; 105:793-801. [PMID: 29182830 DOI: 10.2169/naika.105.793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
8
|
Chidambaram R. A Cautionary Tale on the Central Venous Catheter: Medical Note for Oral Physicians. Malays J Med Sci 2015; 22:78-84. [PMID: 28239272 PMCID: PMC5295746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 06/03/2015] [Indexed: 06/06/2023] Open
Abstract
Complexity in the health status of patients with kidney disease forces to seek the aid of medical devices such as the central venous catheter (CVC) that is essential in order to perform hemodialysis. Elementary information about the CVC, as required for the oral healthcare professionals, has been documented so as to serve as a medical manual. This communication is the first of its kind that conjointly delineates vital considerations, which precede dental maneuvers in patients implanted with a CVC.
Collapse
Affiliation(s)
- Ramasamy Chidambaram
- Correspondence: Dr Ramasamy Chidambaram, BDS (Annamalai University), MDS (Sri Ramachandra University), Department of Prosthodontics, Faculty of Dentistry, AIMST University, Semeling 08100, Jalan Bedong, Kedah Darul Aman, Malaysia, Tel: +9016–472 4370, Fax: +604-429 8009,
| |
Collapse
|
9
|
Muxfeldt ES, de Souza F, Margallo VS, Salles GF. Cardiovascular and renal complications in patients with resistant hypertension. Curr Hypertens Rep 2015; 16:471. [PMID: 25079852 DOI: 10.1007/s11906-014-0471-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
With an increased prevalence, resistant hypertension is recognized as an entity with a high cardiovascular morbidity and mortality. In a large cohort of patients with resistant hypertension, the crude incidence rate of total cardiovascular events reached 4.32 per 100 patient-years of follow-up (19.6 %), with a cardiovascular mortality of 8.3 % (incidence rate of 1.72 per 100 patient-years). Cardiovascular event rates are significantly higher in resistant hypertensives compared with non-resistant (18.0 % versus 13.5 %). In the same way, the prevalence of established cardiovascular and renal disease, as the asymptomatic organ damage (represented by left ventricular hypertrophy, carotid wall thickening, arterial stiffness, and microalbuminuria) is higher in these patients. Many studies have demonstrated a strong association between damage to these organs with higher blood pressure levels, the diagnosis of true resistant hypertension, and refractory hypertension. All efforts should be employed in order to control blood pressure and also to regress and/or prevent subclinical cardiovascular and renal damage. The focus should be on prevention of cardiovascular and renal complications, improving the prognosis of resistant hypertension.
Collapse
Affiliation(s)
- Elizabeth S Muxfeldt
- Department of Internal Medicine, University Hospital Clementino Fraga Filho, Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil,
| | | | | | | |
Collapse
|
10
|
Comparative Epidemiology of Resistant Hypertension in Chronic Kidney Disease and the General Hypertensive Population. Semin Nephrol 2014; 34:483-91. [DOI: 10.1016/j.semnephrol.2014.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|