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Kidney Int. 2019 Jul 25. pii: S0085-2538(19)30512-5. doi: 10.1016/j.kint.2019.04.032. [Epub ahead of print]

Considerable international variation exists in blood pressure control and antihypertensive prescription patterns in chronic kidney disease.

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Renal and Cardiovascular Epidemiology Team, Paris Saclay University, Paris-Sud Univ, UVSQ, CESP, INSERM U1018, Villejuif, France.
BC Renal Agency, University of British Columbia, Vancouver, British Columbia, Canada.
Division of Nephrology and Kidney Center, Tokai University School of Medicine, Isehara, Japan.
Centre for Chronic Disease, Faculty of Medicine, University of Queensland, Queensland, Australia.
School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Brazil.
Nephrological Center, Villingen-Schwenningen, Germany.
Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA.
Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Renal Division, Peking University Institute of Nephrology, Peking University First Hospital, Beijing, China.
Department of Nephrology and Medical Intensive Care, Charité, Universitätsmedizin Berlin, Berlin, Germany; Department of Nephrology and Hypertension, University of Erlangen-Nürnberg, Erlangen, Germany.
George Institute for Global Health, University of New South Wales, New Delhi, India.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
NRHP-URU, Centro de Dialisis CASMU, Montevideo, Uruguay.
Department of Internal Medicine IV, Nephrology and Hypertension, Innsbruck Medical University, Innsbruck, Austria.
Division of Nephrology, Department of Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK.
Departments of Biostatistics and Epidemiology, and Medicine and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Renal and Cardiovascular Epidemiology Team, Paris Saclay University, Paris-Sud Univ, UVSQ, CESP, INSERM U1018, Villejuif, France. Electronic address:


Although blood pressure (BP) control is a major goal in chronic kidney disease (CKD), no worldwide overview of either its achievement or antihypertensive prescriptions is currently available. To evaluate this we compared crude prevalence of uncontrolled BP among 17 cohort studies, including 34 602 individuals with estimated glomerular filtration rate under 60 ml/min/1.73 m2 and treated hypertension across four continents, and estimated observed to expected prevalence ratios, adjusted for potential confounders. Crude prevalence of BP of 140/90 mm Hg or more varied from 28% to 61% and of BP of 130/80 or more from 54% to 84%. Adjusted prevalence ratios indicated poorer hypertension control than expected in cohorts from European countries, India, and Uruguay, and better control in patients from North American and high-income Asian countries. Four antihypertensive drug classes or more were prescribed to more than 30% of participants in North American and some European cohorts, but this practice was less common elsewhere. Renin angiotensin-aldosterone system (RAAS) inhibitors were the most common antihypertensive drugs, prescribed for 54% to 91% of cohort participants. Differences for other drug classes were much stronger, ranging from 11% to 79% for diuretics, 22% to 70% for beta-blockers, and 27% to 75% for calcium-channel blockers. The confounders studied explain only a part of the international variation in BP control among individuals with CKD. Thus, considerable heterogeneity in prescription patterns worldwide calls for further investigation into the impact of different approaches on patient outcomes.


antihypertensive treatment; chronic kidney disease; hypertension control; international health


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