Management of patients with hypertension and chronic kidney disease referred to Hypertension Excellence Centres among 27 countries. On behalf of the European Society of Hypertension Working Group on Hypertension and the Kidney

Figures & data

Table 1. Initial treatments among all patients and patients with CKD in ESH-ECS.

	n	Median	IQR	Min	Max	p Value
Among all patients
Angiotensin-converting enzyme inhibitors (mono/combination) (%)	67	40	30–60	5	90	.6066
Angiotensin-receptor blockers (mono/combination) (%)	66	50	35–70	10	95	.4501
Calcium-channel blockers (%)	67	60	50–80	10	100	.0600
Thiazides (%)	67	50	30–70	15	100	.3372
Loop diuretics (%)	66	15	10–25	5	80	.4488
Beta-blockers (%)	67	25	15–40	5	80	.6516
Among CKD patients
Angiotensin-converting enzyme inhibitors (mono/combination) (%)	66	40	30–60	10	95	.2877
Angiotensin-receptor blockers (mono/combination) (%)	66	43	30–60	10	100	.6526
Calcium-channel blockers (%)	65	70	50–80	15	100	.6932
Thiazides (%)	64	42.5	20–60	5	100	.1973
Loop diuretics (%)	65	30	20–50	5	80	.1829
Beta-blockers (%)	65	30	20–40	5	90	.7990

Notes: p Values: comparisons of treatments among all ESH-ECS. ESH-ECS: European Society of Hypertension Excellent Centres.

Table 2. Treatment of CKD patients and proportion of patient with uncontrolled hypertension.

Proportion of CKD patients in whom specific treatments are initiated	n	Median	IQR	Min	Max	p Value
Proportion of CKD patients in whom ACEI/ARB are initiated	66	90	70–95	5	100	.5293
Proportion of CKD patients in whom MRA are initiated	66	20	10–30	5	50	.0686
Proportion of CKD patients in whom SGLT21 are initiated	65	30	20–50	5	100	.1397
Proportion of CKD patients in whom GLP1-RA are initiated	63	10	5–15	5	35	.0966
Proportion of patients with uncontrolled hypertension after treatment optimization
CKD patients (%)	63	30	15–40	5	90	.4235
All patients (%)	62	18	10–25	5	80	.3051

Note: CKD: chronic kidney disease; MRA: mineracorticoid receptor antagonist; SGLT2i: sodium-glucose transporter inhibitors; GLP1-RA: glucagon-like peptide 1 receptor-agonist; IQR: interquartile range.

Figure 1. Barriers to RAS blockers’ optimisation according to responders (%) (among hyperkalemia, cough, AKI and low GFR).

Barriers to RAS blockers optimisation, from 1, i.e. the most important/frequent, to 4, i.e. the least frequent/least important.

Table 3. barriers to RAS blockers in CKD patients.

Barriers to RAS blockade optimization (1 to 4) in CKD patients		1	2	3	4^a	p Value
Cough (%)	64	25	12.5	12.5	50	.9766
Hyperkalemia (%)	65	32.3	29.2	27.7	10.8
Acute kidney injury after RAS blockade challenge (%)	65	15.4	24.6	50.8	9.2
eGFR considered too low (i.e. usually <30 ml/min) (%)	65	12.3	35.4	26.2	26.2

Note: RAS: renin angiotensin system; eGFR: estimated glomerular filtration rate.

^a1 (the most important/frequent) to 4 (least frequent/least important).

Table 4. Management of non-severe hyperkalemia.

Non-severe hyperkalemia management	n	Median	IQR	Min	Max	p Value
Among patients with hyperkalemia (5.5 to 5.9 mmol/L) treated with RAS blockers
Proportion of K + lowering treatments considered (%)	65	30	10–80	5	100	.5028
Proportion of dosage reduction of RAS blockers (%)	67	45	20–80	5	100	.7954
Proportion of patients without treatment modification	56	10	5−37.5	5	95	.2477

Notes: p Values for differences among European Society of Hypertension-Excellent Centres; RAS: renin angiotensin system; IQR: interquartile range.

Table 5. Major unmet needs at the GP and ESH-ECS levels to improve management of patients with CKD.

Adequate management in hypertensive patients with CKD
GP level	ESH-ECS level
UACR / eGFR yearly measurement	Implementation of BP goal (pharmacological and non pharmacological aspects)
Add or maintain RAS blockers, introduce SGLT2i	Add SGLT2i and MRA according to local regulations
Increase use of RAS blockers, reintroduce them if stopped	Do not reduce or withdraw RAS blockers/MRA in mild to moderate hyperkalemia (5.5–5.9 mmol/l)

Note: UACR: urinary albumin creatinine ratio; RAS blockers: renin angiotensin system blockers; SGLT2i: sodium-glucose transporter inhibitors; MRA: mineralocorticoid receptor antagonists; GP: general practitioners; ESH-ECs: European Society of Hypertension Excellent Centres.