Controlling systolic blood pressure is difficult in patients with diabetic kidney disease exhibiting moderate‐to‐severe reductions in renal function

Abstract

This study compared the use of antihypertensive treatment and blood pressure (BP) controls between patients with diabetic kidney disease (DK+) and patients with non‐diabetic kidney disease (DK−) exhibiting moderate‐to‐severe chronic renal failure who did not need renal replacement therapy. A cross‐sectional survey included all renal patients with s‐creatinine at ⩾200 µmol/l attending regular control sessions at six renal units in Norway. Of the 351 patients included, 73 (20.8%) were DK+. The proportion reaching a BP goal of <130/80 mmHg was similar in DK+ and DK− (14.1% vs 13.6%, p = 0.92), while 38% and 39% achieved a BP of <140/90 mmHg, respectively. The systolic BP goal was more difficult to achieve than the diastolic BP goal in DK+ patients (35% vs 15%) despite a mean of three different types of drugs being used. Loop diuretics and beta‐adrenergic‐receptor antagonists were the most frequently prescribed drugs, and the use of angiotensin‐converting enzyme inhibitors or angiotensin‐II‐receptor antagonists declined when renal function deteriorated, from 80% to 0% and from 66% to 20% in the DK+ and DK− groups, respectively (p = 0.001). Thus, despite the use of multiple antihypertensive drugs, controlling BP – especially the systolic BP – is difficult in high‐risk patients with chronic renal failure caused by diabetic kidney disease.

• Antihypertensive drugs
• blood pressure control
• chronic renal failure
• diabetic kidney disease