TITLE:
Physician’s Awareness of Home Blood Pressure in the Treatment of Hypertensive Patients with Chronic Kidney Disease
AUTHORS:
Naoki Sugano, Satoru Kuriyama, Yoichiro Hara, Koki Takane, Yasuhito Takahashi, Yasuko Suetsugu, Takashi Yokoo
KEYWORDS:
Home Blood Pressure; Chronic Kidney Disease; Guideline for High Blood Pressure; Antihypertensive Agents
JOURNAL NAME:
Open Journal of Nephrology,
Vol.4 No.1,
March
24,
2014
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.