Prevalence of hypertension in renal disease

Background. Hypertension (HTN) is very frequent in patients with renal dise ase and its prevalence increases as renal failure progresses. Methods. We studied the prevalence of HTN in 1921 patients with different n ephropathies. Patients on dialysis and renal transplant patients were not i ncluded in the study. HTN was defined as SBP>140 and/or DBP>90 mmHg, or req uiring antihypertensive therapy. Results. The prevalence of HTN in the total group of patients with renal di seases was 60.5%, but this prevalence varied widely depending upon the type of underlying nephropathy. The prevalence of HTN was practically universal in patients with renal vascular disease (93%) and in patients with establi shed diabetic nephropathy (87%), and 74% of the patients with polycystic ki dney disease, 63% of the patients with chronic pyelonephritis and 54% of th e patients diagnosed with glomerulonephritis were hypertensive. The prevale nce of HTN in patients with renal insufficiency (80%) is significantly high er than that in patients without renal insufficiency (43% P<0.001). In a mu ltiple logistic regression analysis, the independent risk factors defining HTN in renal patients were: renal failure, age, the presence of diabetes, h ypertriglyceridaemia and proteinuria. Antihypertensive treatment consisted of diet alone in 4% of the patients, one drug in 45%, two drugs in 36%, thr ee medications in 13% and more than three drugs in 2.5%. The angiotensin-co nverting enzyme (ACE) inhibitors were the most frequently prescribed drug ( 39% of the patients treated in monotherapy) followed by calcium channel blo ckers (27%), diuretics (18%) and <beta>-blockers (9%). The most common comb ined therapy was a diuretic plus an ACE inhibitor. The percentage of patien ts with BP controlled according to current recommendations for renal patien ts (BP<130/85) was very low; SEP in only 49% and DBP in 24%. Control of bot h was only achieved in 10% of the patients. Conclusions, There is a high prevalence of HTN in renal patients, which dep ends on the type of nephropathy and the degree of renal failure. Other inde pendent risk factors for HTN in patients with renal disease are: advanced a ge, the presence of diabetes, hypertriglyceridaemia and the severity of pro teinuria. BP control in renal patients is quite poor and should be improved to reduce progression of the renal disease.