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Blood pressure control and comorbidity in a nephrology clinic.

BACKGROUND
Many patients with established hypertension have poorly controlled blood pressure (BP). We studied demographic and clinical characteristics related to hypertension and analyzed the relationships between BP control and comorbidity.


METHODS
This study was based on 414 consecutive hypertensive out-patients referred to our nephrology clinic. We recorded systolic and diastolic BP, age, gender, body mass index, total cholesterol, family history of hypertension, glomerular filtration rate (GFR), 24-hr proteinuria, diabetes, coronary artery disease, smoking habits and antihypertensive drug treatment. BP control was considered optimal if BP was < 130/80 mmHg in patients with diabetes or chronic kidney disease (CKD), if BP was < 125/75 mmHg in CKD with proteinuria > 1 g/24 hr and if BP was < 140/90 mmHg in patients with no comorbidity. Multivariate logistic regression analysis was used to investigate the association between BP control and predictors.


RESULTS
Only 26.6% of patients had adequately controlled BP. Eighty-five percent of patients aged > 65 yrs had uncontrolled systolic hypertension. Univariate analysis showed a significant association between poor BP control and age >65 yrs, family history of hypertension, diabetes, CKD with or without proteinuria > 1 g/24 hr and total cholesterol > 220 mg/dL. Multivariate logistic regression showed that age > 65 yrs, diabetes and CKD with or without proteinuria > 1 g/24 hr were significantly and independently associated with poor BP control.


CONCLUSIONS
Inadequate hypertension control is a common cause for referral to our out-patient nephrology clinic. Our data confirm that elderly patients, diabetic patients and nephropathic patients are difficult to treat; and therefore, deserve the highest quality clinical attention.