Abstract
Aim: The majority of guidelines recommended the significance of home-based blood pressure (home-BP) measurement. The present study explored that to what extent, general practitioners (GPs) were aware of the importance of home-BP in the daily clinical practice. Method: We sent out questionnaires to GPs who had been specialized in nephrology and hypertension. The questions focused on the awareness of home-BP and the selections of antihypertensive agents for refractory hypertension in chronic kidney disease (CKD) patients. Results: 1) The majority (95.9%) of the responding GPs had utilized home-BP in their clinical practice. 2) When prescribing a single agent for hypertensive CKD patients, the majority of GPs (87.3%) chose ARB for the first line drug, and Ca channel blockers (CCB) were the second. 3) As an add-on drug to the pre-treatment with an angiotensin receptor blocker (ARB), the majority preferred CCB (82.7%) to diuretics (21.8%). In addition, a fixed combination formula of antihypertensive medication consisting of ARB plus diuretic was accepted by the majority of GPs (78.7%). 4) To improve morning hypertension in patients treated with two or more drugs, 87.8% of the doctors agreed that additional night-time dosing could be useful. The choices of the agents given at night-time varied, mainly with α1-blockers (40.6%), followed by α-blockers (30.5%) and α-methyldopa (19.8%). Conclusion: The majority of GPs in Japan are aware of the importance of the home-BP-based management of CKD. They mainly chose ARB as a first line drug, and ARB plus CCB as an add-on therapy.
Highlights
Three different methods of BP measurement are office BP, home-BP measured at any given time of the day and 24-hours ambulatory BP (ABP) monitoring
A fixed combination formula of antihypertensive medication consisting of angiotensin type receptor blocker (ARB) plus diuretic was accepted by the majority of general practitioners (GPs) (78.7%). 4) To improve morning hypertension in patients treated with two or more drugs, 87.8% of the doctors agreed that additional night-time dosing could be useful
Despite very few head-to-head comparisons between homeBP and ABP, the results constantly showed that both were reliable in predicting the target-organ damage in hypertensive patients [16]-[19]
Summary
Three different methods of BP measurement are office BP, home-BP measured at any given time of the day (home-BP) and 24-hours ambulatory BP (ABP) monitoring. The two latter methods are home-based BP, which give lots of advantages including; 1) it provides multiple measurement of BP in any occasion by days, weeks, months or years; 2) it is obtained in a usual environment for each individual which can avoid white-coat effect; 3) it can detect the white-coat, masked and morning hypertension; and 4) it is closely related to target organ damage and predicts the risk of cardiovascular events. In longitudinal studies, BP values of home-based BP predict the progression of organ damage and the risk of cardiovascular disease more accurately than office BP [5]-[10]. These data support the notion that home-based BP is a highly valuable tool in the management of hypertension [11]-[15]. Despite very few head-to-head comparisons between homeBP and ABP, the results constantly showed that both were reliable in predicting the target-organ damage in hypertensive patients [16]-[19]
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