OPTIMAL BLOOD PRESSURE CONTROL: ARE NEPHROLOGISTS FAR AWAY FROM THE TARGET ?

Optimal blood pressure control is essential to prevent target organ damage. Even though the need to lower blood pressure in essential hypertension has been long ago recognized, many reports show that optimal blood pressure control is achieved in a small percentage of the hypertensive population treated by general practitioners, cardiologists, and hypertension specialists. This study was performed to found characterizing differences of hypertensive patients who attain nephrology clinics in Italian regions and to evaluate how hypertension is managed by nephrologists. The latter is an important point being blood pressure control one of the most effective ways to prevent the onset and/or to reduce the progression of renal failure. Questionnaire were send to Nephrology Clinics based at Hospitals and/or Universities in most of Italian regions. Questions were pertinent to clinical characteristics and patients lifestyle: age, gender, BW, height, habits (smoke, alcohol, coffee) as well as cause and onset of hypertension, blood pressure at the entry and at last visit, and antihypertensive drugs (single drugs or association). Biochemical data were gathered: urea, creatinine, creatinine clearance (Ccr), glucose, cholesterol, triglycerides, serum sodium, plasma potassium, 24-h sodium and potassium urinary excretion (UNa, UK), urinary protein excretion (Uprot). Data were evaluated in aggregate and according to Regions (North, Center, South of Italy) to evaluate possible geographical differences in patients habits, policy of nephrologists and attained blood pressure target. Data pertinent to 1632 patients were analyzed. Only small not significant differences were found among the three geographical areas. In aggregate patients characteristics were: male gender 53.7%, mean age: 58±15 y, BW: 72±3.8, eight: 167±9 cm, smoke in 44%, alcohol in 32%, coffee in 90%. Biochemistry was: urea: 71±52 mg/dL, creatinine 2.3±2.1 ml/min, cholesterol: 220±53 mg/dL, triglycerides: 160±97 mg/dL, sodium 141±3 mEq/L, potassium 4.4±0.6 mEq/L, UNa:121±67 mEq/24h, UK: 40±19 mEq/24h, Ccr was normal in 47% of patients. Hypertensive patients had: essential hypertension (38%), chronic renal failure (16%), diabetes (11%), glomerulonephritis (10%). Correlation was found between systolic blood pressure and Uprot (p<0.01), UNa (p<0.02), Ccr (p<0.0001), triglycerides (p<0.01), cholesterol (p<0.001); diastolic blood pressure was correlated with number of cigarettes (p<0.002) and coffee cups (p<0.0001). Drugs administered were: diuretics [36%; most prescribed (MP): furosemide], betablockers (17%; MP: atenolol), DHCCBB (51%; MP: nifedipine retard), NDHCCBB (3%; MP: verapamil), ACE-I (48%; MP: enalapril), peripheral vasodilators (12%; MP: doxazosin), central acting agents ( 16%; MP: clonidine). At last visit systolic blood pressure was ≤140 mmHg in 39% of patients (the percentage at entry was 1%), diastolic blood pressure was ≤90 mmHg in 77% (a the entry 5%). These data clearly demonstrate that an excellent improvement in blood pressure control is obtained by nephrologists in non selected hypertensive out-patients. However, while diastolic blood pressure appears controlled in a large percentage of cases, further efforts are still needed to reach an optimal blood pressure control of systolic blood pressure. Keywords: hypertension; epidemiology; progression of renal disease; calclium blockers Session: Poster Session I: Hypertension: clinical