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

ABSTRACT

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.

KEYWORDS:

• Antihypertensives
• adequate blood pressure
• diabetes
• hypertension
• chronic kidney disease

Acknowledgments

The authors acknowledge the staff of the Diabetes and Endocrinology Unit and Renal Outpatient clinics for facilitating access to their patients during the study period and the staff of Central Health Records and Information Department of Kenyatta National Hospital for granting access to patient medical records during data collection.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

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Additional information

Funding

This paper was not funded.