Current features of management of comorbid patients with hypertension

The article presents an analysis of the current state of the problem of managing patients with arterial hypertension (AH) and various comorbid backgrounds. Also, it highlights the current guidelines (2018) for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. Information on new target blood pressure (BP) values in the range of 120–130 mm Hg is emphasized for systolic blood pressure (SBP) and 70–80 mm Hg for the diastolic (DAD) one in the majority of patients with the exception of persons of 65 years and older, as well as patients with chronic kidney disease, who have been recommended to achieve a blood pressure of 130–139 mm Hg. Furthermore, his material presents the current views on the priority of combined (initially double, and triple in the case of failure), mainly fixed antihypertensive therapy, the choice of which requires the presence and nature of comorbid pathology.

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RESISTANT ARTERIAL HYPERTENSION IN PATIENTS WITH CHRONIC KIDNEY DISEASE: PREVALENCE, PROGNOSTIC SIGNIFICANCE, REASONS AND APPROACHES TO ANTIHYPERTENSIVE THERAPY

Nephrology (Saint-Petersburg) ◽

10.24884/1561-6274-2019-23-1-37-44 ◽

2019 ◽

Vol 23 (1) ◽

pp. 37-44 ◽

Cited By ~ 1

Author(s):

O. B. Kuzmin ◽

V. V. Zhezha ◽

L. N. Landar ◽

O. A. Salova

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Drug Therapy ◽

Kidney Disease ◽

Arterial Hypertension ◽

Antihypertensive Therapy ◽

Resistant Hypertension ◽

Antihypertensive Drugs ◽

Refractory Hypertension ◽

Hypertensive Patients

Arterial hypertension (AH) resistant to drug therapy is the phenotype of uncontrolled AH, in which patients receiving at least 3 antihypertensive drugs, including a diuretic, maintain blood pressure above the target level. Initially, the term refractory hypertension was also used to refer to resistant hypertension. Recently, however, refractory hypertension has been isolated into a separate phenotype of difficult to treat hypertension, which is defined as insufficient control of target blood pressure, despite the use of at least 5 different mechanisms of antihypertensive drugs, including long-acting diuretic and antagonist of mineralcorticoid receptors. Resistant hypertension is detected in 10–15 % of all hypertensive patients receiving drug therapy, and is often found in patients with chronic kidney disease. Hypertension can be a cause and/or consequence of kidney damage and is typical of most patients with chronic kidney disease. The lack of control of target blood pressure in a significant proportion of hypertensive patients with CKD who receive at least 3 antihypertensive drugs of different mechanisms of action indicates a lack of effectiveness of antihypertensive therapy, which not only accelerates the loss of renal function, but also significantly worsens the prognosis, contributing to such people risk of cardiovascular and renal complications. The review presents data on the prevalence, prognostic value of resistant hypertension in patients with chronic kidney disease, features of its formation and approaches to increasing the effectiveness of antihypertensive therapy in this patient population.

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A clinical case of refractory arterial hypertension

Spravočnik vrača obŝej praktiki (Journal of Family Medicine) ◽

10.33920/med-10-2104-08 ◽

2021 ◽

pp. 56-63

Author(s):

Dmitriy Sergeevich Kovalev

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Arterial Hypertension ◽

Antihypertensive Therapy ◽

Clinical Case ◽

Blood Pressure Level ◽

Pressure Level ◽

Entire Population ◽

Treatment Refractory

Arterial hypertension is considered treatment refractory (resistant), if the treatment, involving a change (improvement) in lifestyle and a rational combined antihypertensive therapy, consisting of three drugs, including a diuretic, in the maximum tolerated doses does not lead to the achievement of the target blood pressure level. Pseudo-refractory and true refractory arterial hypertension are distinguished. According to modern data, true refractory arterial hypertension occurs in no more than 5 % of cases among the entire population of patients with arterial hypertension, however, in certain groups of patients, for instance, with chronic kidney disease, its prevalence can reach 30–50 %. The article presents a clinical case of diagnosis and treatment of refractory arterial hypertension.

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Current Guidelines for the Treatment of Arterial Hypertension in Patients with Diabetes Mellitus and Chronic Kidney Disease

Rational Pharmacotherapy in Cardiology ◽

10.20996/1819-6446-2021-04-06 ◽

2021 ◽

Vol 17 (2) ◽

pp. 323-331

Author(s):

T. Yu. Demidova ◽

O. A. Kislyak

Keyword(s):

Diabetes Mellitus ◽

Blood Pressure ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Arterial Hypertension ◽

Antihypertensive Therapy ◽

Enzyme Inhibitor ◽

Angiotensin Ii Receptor Blocker ◽

Prevention And Treatment ◽

Patients With Diabetes

The current understanding of the management of patients with diabetes mellitus (DM) based on the concept of the cardiovascular continuum involves not only the prevention and treatment of cardiovascular diseases (CVD), but also the prevention and treatment of chronic kidney disease (CKD). The fact is that patients with DM and CKD represent a special group of patients with a very high risk of CVD and cardiovascular mortality. Such patients require early diagnosis and timely identification of risk factors for the development and progression of CKD for their adequate correction. Arterial hypertension, along with hyperglycemia, is the main risk factor for the development and progression of CKD in patients with diabetes. In this regard, the choice of antihypertensive therapy (AHT) in patients with diabetes is of particular importance. The basis of AHT in diabetes and CKD is the combination of a blocker of the renin-angiotensin-aldosterone system (an angiotensin-converting enzyme inhibitor [ACE inhibitor] or an angiotensin II receptor blocker [ARB]) and a calcium channel blocker (CCB) or a thiazide / thiazide-like diuretic. The task of the performed AHT is to achieve the target level of blood pressure (BP). At the same time, the optimal blood pressure values in patients with diabetes and CKD are blood pressure values in the range of 130-139/70-79 mm Hg. If the target blood pressure is not achieved, it is necessary to intensify antihypertensive therapy by adding a third antihypertensive drug to the therapy: CCB or a diuretic (thiazide / thiazide-like or loop). In case of resistant hypertension, it is necessary to consider the possibility of adding antagonists of mineralocorticoid receptors, other diuretics or alpha-blockers to the conducted AHT. Beta-blockers can be added at any stage of therapy if the patient has exertional angina, a history of myocardial infarction, atrial fibrillation, and chronic heart failure. The need to normalize blood pressure parameters by prescribing combined antihypertensive therapy in patients with diabetes and CKD is explained by a decrease in renal and cardiovascular risks, and, therefore, a decrease in the risk of mortality in this cohort of patients.

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Chronic Kidney Disease among Diabetes Patients in Ethiopia: A Systematic Review and Meta-Analysis

International Journal of Nephrology ◽

10.1155/2020/8890331 ◽

2020 ◽

Vol 2020 ◽

pp. 1-15

Author(s):

Wondimeneh Shibabaw Shiferaw ◽

Tadesse Yirga Akalu ◽

Yared Asmare Aynalem

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Diabetic Retinopathy ◽

Kidney Disease ◽

Glycemic Control ◽

High Density Lipoprotein ◽

Systolic Blood Pressure ◽

Meta Analysis ◽

Density Lipoprotein ◽

Diabetes Patients

Background. Though different primary studies have reported the burden of chronic kidney disease among diabetes patients, their results have demonstrated substantial variation regarding its prevalence in Ethiopia. Therefore, this study aimed to estimate the pooled prevalence of chronic kidney disease and its associated factors among diabetes patients in Ethiopia. Method. PubMed, African Journals Online, Google Scholar, Scopus, and Wiley Online Library were searched to identify relevant studies. The I2 statistic was used to check heterogeneity across the included studies. A random-effects model was applied to estimate the pooled effect size across studies. A funnel plot and Egger’s regression test were used to determine the presence of publication bias. All statistical analyses were performed using STATA™ version 14 software. Result. In this meta-analysis, a total of 12 studies with 4,075 study participants were included. The estimated prevalence of CKD among diabetes patients was found to be 35.52% (95% CI: 25.9–45.45, I2 = 96.3%) for CKD stages 1 to 5 and 14.5% (95% CI: 10.5–18.49, I2 = 91.1%) for CKD stages 3 to 5. Age greater than 60 years (OR = 2.99; 95% CI: 1.56–5.73), female sex (OR = 1.68; 95% CI: 1.04–2.69), duration of diabetes >10 years (OR = 2.76; 95% CI: 1.38–5.51), body mass index >30 kg/m2 (OR = 2.06; 95% CI: 1.41–3.00), type 2 diabetes (OR = 2.54; 95% CI: 1.73–3.73), poor glycemic control (OR = 2.01; 95% CI: 1.34–3.02), fasting blood glucose >150 mg/dl (OR = 2.58; 95% CI: 1.79–3.72), high density lipoprotein >40 mg/dl (OR = 0.48; 95% CI: 0.30–0.85–25), systolic blood pressure>140 mmHg (OR = 3.26; 95% CI: 2.24–4.74), and diabetic retinopathy (OR = 4.54; CI: 1.08–25) were significantly associated with CKD. Conclusion. This study revealed that the prevalence of chronic kidney disease remains high among diabetes patients in Ethiopia. This study found that a long duration of diabetes, age>60 years, diabetic retinopathy, female sex, family history of kidney disease, poor glycemic control, systolic blood pressure, overweight, and high level of high-density lipoprotein were associated with chronic kidney disease among diabetic patients. Therefore, situation-based interventions and context-specific preventive strategies should be developed to reduce the prevalence and risk factors of chronic kidney disease among diabetes patients.

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Modifying Effect of Statins on Fatal Outcomes in Chronic Kidney Disease Patients in the Systolic Blood Pressure Intervention Trial: A Post Hoc Analysis

American Journal of Nephrology ◽

10.1159/000499188 ◽

2019 ◽

Vol 49 (4) ◽

pp. 297-306 ◽

Cited By ~ 1

Author(s):

Manuel Rivera ◽

Leonardo Tamariz ◽

Maritza Suarez ◽

Gabriel Contreras

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Systolic Blood Pressure ◽

Statin Therapy ◽

Statin Group ◽

All Cause Mortality ◽

Modifying Effect ◽

Post Hoc ◽

Event Rates

Background: Management of chronic kidney disease (CKD) patients includes efforts directed toward modifying traditional cardiovascular risk factors. Such efforts include optimal management of hypertension together with the initiation of statin therapy. Methods: In this observational study, we determine the modifying effect of statins on the relationship of systolic blood pressure (SBP) goal with mortality and other outcomes in patients with CKD participating in a clinical trial. At baseline, 2,646 CKD patients (estimated glomerular filtration rate < 60 mL/min/1.73 m2) were randomized to an intensive SBP goal < 120 mm Hg or standard SBP goal <140 mm Hg. One thousand two hundred and seventy-three were not on statin, 1,354 were on a statin, and in 19 the use of statin was unknown. The 2 primary outcomes were all-cause mortality and cardiovascular disease (CVD) mortality. Results: The relationships of SBP goal with all-cause mortality (interaction p = 0.009) and cardiovascular (CV) mortality (interaction p = 0.021) were modified by the use of statin after adjusting for age, gender, race, CVD history, smoking, aspirin use, and blood pressure at baseline. In the statin group, targeting SBP to < 120 mm Hg compared to SBP < 140 mm Hg significantly reduced the risk of all-cause mortality (adjusted hazard ratio [aHR] 0.44 [0.28–0.71]; event rates 1.16 vs. 2.5 per 100 patient-years) and CV mortality (aHR 0.29 [0.12–0.74]; event rates 0.28 vs. 0.92 per 100 patient-years) after a median follow-up of 3.26 years. In the non-statin group, the risk of all-cause mortality (aHR 1.07 [0.69–1.66]; event rates 2.01 vs. 1.94 per 100 patient-years) and CV mortality (aHR 1.42 [0.56–3.59]; event rates 0.52 vs. 0.41 per 100 patient-years) were not significantly different in both SBP goal arms. Conclusion: The combination of statin therapy and intensive SBP management leads to improved survival in hypertensive patients with CKD.

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