Management of hypertension in patients developing endstage renal failure

The benefits of treating hypertension include preventing or delaying the pr ogression of chronic renal failure, and reducing the cardiovascular complic ations of patients with renal disease. We examined how well hypertension ha d been managed in all 145 patients from a single health district who starte d dialysis during a S-year period. Data relating to management of hypertens ion, including all blood pressure readings, were obtained from their genera l practice and hospital case notes. The anonymized data were reviewed by tw o independent assessors against a set of standards based on the British Hyp ertension Society guidelines. There was close agreement between the assesso rs. Complete records were obtained in 98.5% of cases. Of the 145 patients, 107 (76.4%) were hypertensive before developing end-stage renal failure. Th ere were departures from standards in all categories of care: 24.3% in dete ction/diagnosis, 29% in investigation, 22.4% in referring to a nephrologist , and 17% in follow-up. The British Hypertension Society recommended standa rd for diastolic blood pressure of 90 mmHg was achieved in only 45%. In 32% , the assessors independently concluded that poor blood pressure control mi ght have affected adversely the progression of renal failure. New methods o f dealing with these problems are required and possible approaches are disc ussed.