Blood pressure and angiotensin converting enzyme inhibitor use in hypertensive patients with chronic renal insufficiency

Abstract

Background Hypertension treatment is important in managing chronic renal insufficiency (CRI). Little is known, however, about the blood pressure (BP) control achieved or the pattern of antihypertensive drug prescription among CRI patients. Methods Using computerized medical records, we studied 3089 adult hypertensive subjects treated at Brigham and Women’s Hospital (Boston, MA) from 1990 through 1998. All subjects had at least two serum creatinine measurements ≥2 years apart, at least two BP readings, and online weight (to estimate Cockcroft-Gault creatinine clearance [CrCl]). Results The average mean arterial pressure over time (mean MAP) was 103 ± 9 mm Hg among those with CrCl >60 mL/min, 102 ± 9 mm Hg among those with CrCl 41 to 60 mL/min, and 101 ± 9 mm Hg among those with CrCl 21 to 40 mL/min. There were no significant differences in mean MAP among the different categories of renal function in the multivariate analysis ( P = .26 for trend). The proportion of patients with final systolic BP <160 mm Hg and diastolic BP <90 mm Hg was 68% and did not vary with renal function ( P = .68 for trend). The proportion of subjects who were prescribed ACE inhibitors was 38% among those with CrCl >60 mL/min, 36% among those with CrCl 41 to 60 mL/min, and only 27% among those with CrCl 21 to 40 mL/min ( P = .003 for trend). Conclusions The BP control achieved among hypertensive CRI subjects, although no worse than that among those without CRI, was found to be suboptimal. Patients with CrCl 21 to 40 mL/min were less likely to be prescribed ACE inhibitors than were those with CrCl >60 mL/min. Improvement is needed in the clinical management of these factors that can influence the progression of CRI.