Antihypertensive prescribing patterns in non-dialysis dependent chronic kidney disease:Findings from the Salford Kidney Study

BACKGROUND Hypertension is commonly observed in patients living with chronic kidney disease(CKD).Finding an optimal treatment regime remains challenging due to the complex bidirectional cause-and-effect relationship between hypertension and CKD.There remains variability in antihypertensive treatment practices.AIM To analyze data from the Salford Kidney Study database in relation to antihypertensive prescribing patterns amongst CKD patients.METHODS The Salford Kidney Study is an ongoing prospective study that has been recruiting CKD patients since 2002.All patients are followed up annually,and their medical records including the list of medications are updated until they reach study endpoints[starting on renal replacement therapy or reaching estimated glomerular filtration rate(eGFR)expressed as mL/min/1.73 m2≤10 mL/min/1.73 m2,or the last follow-up date,or data lock on December 31,2021,or death].Data on antihypertensive prescription practices in correspondence to baseline eGFR,urine albumin-creatinine ratio,primary CKD aetiology,and cardiovascular disease were evaluated.Associations between patients who were prescribed three or more antihypertensive agents and their clinical outcomes were studied by Cox regression analysis.Kaplan-Meier analysis demonstrated differences in survival probabilities.RESULTS Three thousand two hundred and thirty non-dialysis-dependent CKD patients with data collected between October 2002 and December 2019 were included.The median age was 65 years.A greater proportion of patients were taking three or more antihypertensive agents with advancing CKD stages(53%of eGFR≤15 mL/min/1.73 m2 vs 26%of eGFR≥60 mL/min/1.73 m2,P<0.001).An increased number of patients receiving more classes of antihypertensive agents was observed as the urine albumin-creatinine ratio category increased(category A3:62%vs category A1:40%,P<0.001),with the upward trends particularly noticeable in the number of individuals prescribed renin angiotensin system blockers.The prescription of three or more antihypertensive agents was associated with all-cause mortality,independent of blood pressure control(hazard ratio:1.15;95%confidence interval:1.04-1.27,P=0.006).Kaplan-Meier analysis illustrated significant differences in survival outcomes between patients with three or more and those with less than three antihypertensive agents prescribed(log-rank,P<0.001).CONCLUSION Antihypertensive prescribing patterns in the Salford Kidney Study based on CKD stage were consistent with expectations from the current United Kingdom National Institute of Health and Care Excellence guideline algorithm.Outcomes were poorer in patients with poor blood pressure control despite being on multiple antihypertensive agents.Continued research is required to bridge remaining variations in hypertension treatment practices worldwide.

Effects of Magnetic Needle Acupuncture on Blood Pressure and Plasma ET-1 Level in the Patient of Hypertension

Endothelin-1 (ET-1) is ever known as a bio-peptidewith the strongest vasoconstrictive action and withwide biological effects.

Effects of terlipressin on systolic pulmonary artery pressure of patients with liver cirrhosis: An echocardiographic assessment

AIM:Portopulmonary hypertension is a serious complication of chronic liver disease.Our aim was to search into the effect of terlipressin on systolic pulmonary artery pressure among cirrhotic patients. METHODS:Twelve patients(6 males and 6 females)with liver cirrhosis were recruited in the study.Arterial blood gas samples were obtained in sitting position at rest.Contrast enhanced echocardiography and measurements of systolic pulmonary artery pressure were performed before and after the intravenous injection of 2 mg terlipressin. RESULTS:Of 12 patients studied,the contrast enhanced echocardiography was positive in 5,and the positive findings in contrast enhanced echocardiography were reversed to normal in two after terlipressin injection.The mean systolic pulmonary artery pressure was 25.5±3.6 mmHg before terlipressin injection,and was 22.5+2.5 mmHg after terlipressin(P=0.003).The systolic pulmonary artery pressure was above 25 mmHg in seven of these 12 patients. After the terlipressin injection,systolic pulmonary artery pressure was<25 mmHg in four of these cases(58.3% vs 25%,P=0.04). CONCLUSION:Terlipressin can decrease the systolic pulmonary artery pressure in patients with liver cirrhosis.

Well Controlled Blood Pressure in Turkish Patients: How Many Drugs Are Required to Attain and Maintain the Blood Pressure Goal?

Background: This study aimed to determine the number of antihypertensive agents required to achieve optimal blood pressure (BP) in Turkish hypertensive patients. Material and Methods: Totally 400 hypertensive patients (114 males and 286 females) were enrolled. BP was measured by patients at home twice a day. The patients were called for controlling in every four weeks, and those who had BP < 140/90 were not followed-up. In patients with BP > 140/90 drug, doses were increased or another antihypertensive drug added and the patients were continued to be followed-up. Results: In the first follow-up (on the 4th week), 152 (38%) patients, including 35 (31%) men and 117 (41%) women, attained the goal BP. The mean duration of hypertension in single, double, triple, and quadruple treatment groups was 6.2 ± 5.0, 6.8 ± 5.9, 8.8 ± 5.4, and 10.4 ± 6.6 years, respectively. In the beginning, the median number of agents used for each patient was 2.17. When the follow-up was concluded, the median of agents used for each patient was 2.72. Conclusion: Thirty-eight percent of participants had controlled hypertension in the first follow-up. Women had better BP control. The median number of agents required for attaining and maintaining BP goal was 2.72. More drugs are needed when hypertension gets longer.

A CLINICAL TRIAL OF TANG SHEN NING FOR TREATMENT OF DIABETIC NEPHROPATHY

This paper reports the clinical trial of Tang Shen Ning ([symbol: see text], TSN) for treating diabetic nephropathy (incipient and clinical, as divided by Mogensen). The results showed that the total effective rate in treatment group (TSN + western medicine) was 90.0%, and that in the control group (simply with western medicine), 56.7%. TSN plays important roles in decreasing proteinuria and improving renal functions.

Analysis of antihypertensive regimens and their intended patients from three hospitals in Beijing

This study aimed to investigate various regimens of antihypertensive agents for different groups of patients and the outcomes in the real world. We retrospectively collected 974 prescriptions for hypertension from three hospitals in Beijing, along with medical records of 219 hypertensive patients from one of the hospitals to study the regimens and their effects on patients. The antihypertensive regimens were classified by different combinations of subclasses of antihypertensive agents. Nearly all prescriptions can be classified into 11 different antihypertensive regimens, and most of them are combination therapy. Grade III hypertension patients significantly （P〈0.001） tend to be treated with regimens containing calcium channel blocker （CCB） and RAAS inhibitors, angiotensin II receptor blocker （ARB） or angiotensin-converting enzyme inhibitor （ACEI）. β-Blockers are more likely to be combined with CCB than with other categories of antihypertensive agents. Hydrochlorothiazide is less widely used than recommended.

Influence of Valsartan on myocardial apoptosis in spontaneously hypertensive rats

OBJECTIVE: To explore the pathogenic changes of myocardial apoptosis in heart hypertrophy during hypertension and evaluate the anti-apoptosis effect of Valsartan. METHODS: Thirty spontaneously hypertensive rats (SHRs) were divided into two groups: 15 treated with Valsartan (20 mg x kg(-1) x d(-1)) (SHR + Valsartan group), the others with placebo (SHR + placebo group), with 15 normal Wistar rats as control. Systolic blood pressure was measured by the tail-cuff method. The observation period was from 8 to 16 weeks of age. Cardiac apoptosis was evaluated by a Terminal Deoxynucleotidyl Transferase-Mediated dUTP-biotin Nick End Labeling (TUNEL) assay. RESULTS: Mean blood pressure values were 127 +/- 2 mm Hg in controls, 163 +/- 6 mm Hg in the SHR + Valsartan group and 193 +/- 7 mm Hg in the SHR + placebo group at 16 weeks of age, whereas the blood pressure in 8-week-old SHR and Wistar rats were 175 +/- 3 mm Hg and 125 +/- 5 mm Hg, respectively. The ratio of the heart weight over body weight declined in Wistar (3.07 +/- 0.03 mg/g) and SHR + Valsartan groups (3.22 +/- 0.19 mg/g) compared with the SHR + placebo group (4.02 +/- 0.31 mg/g) (P