Utilization of antihypertensive drugs among chronic kidney disease patients: Results from the Chinese cohort study of chronic kidney disease (C-STRIDE)

Bianling Liu, Qin Wang, Yu Wang, Jinwei Wang, Luxia Zhang, Minghui Zhao, C-STRIDE study group, Bianling Liu, Qin Wang, Yu Wang, Jinwei Wang, Luxia Zhang, Minghui Zhao, C-STRIDE study group

Abstract

The utilization of antihypertensive drugs plays an important role in blood pressure control among chronic kidney disease (CKD) patients. Limited information was available on how antihypertensive drugs were used among Chinese CKD patients. In the present study, the utilization of antihypertensive drugs among a subgroup of hypertensive participants with a complete record of antihypertensive drug information from the Chinese Cohort Study of Chronic Kidney Disease was analyzed. Among 2213 subjects, 61.7% and 26.5% had their blood pressure controlled to <140/90 mmHg and <130/80 mmHg, respectively. In total, 38.5% were on monotherapy. Of those patients who received combination therapy, 57.8% were treated with a two-drug combination. Renin-angiotensin system inhibitors (RASIs) were the most commonly prescribed drugs (71.2%). Only 10.2% of the patients were prescribed diuretics. After multivariable adjustment, participants taking RASI were more likely to have their blood pressure controlled to <140/90 mmHg (prevalence ratio (PR) 1.153, 95% confidence interval (CI): 1.071-1.240). CKD stage 4 (PR 0.548, 95% CI: 0.434-0.692) was associated with RASIs treatment. Additionally, diabetes (PR 1.498, 95% CI: 1.120-2.004), albumin/creatinine ratio ≥300 mg/g (PR 1.547, 95% CI: 1.020-2.344), and CKD stage 4 (PR 2.022, 95% CI: 1.223-3.343) were associated with diuretic use. The results suggested that combination therapy, diuretics use in general, and utilization of RASIs in advanced CKD stage were insufficient in the current treatment of Chinese hypertensive CKD patients.

Keywords: antihypertensive therapy; chronic kidney disease; diuretic; hypertension; renin-angiotensin system inhibitor.

Conflict of interest statement

The authors report no specific funding in relation to this research and have no conflicts of interest to disclose.

© 2019 Wiley Periodicals, Inc.

Figures

Figure 1
Figure 1
Utilization pattern of antihypertension drugs in different CKD stages. A. Percentage of the number of antihypertension drugs utilized in the cohort; B. percentage of the number of antihypertension drugs utilized in the combination group; C. percentage of the number of antihypertension drugs utilized in each CKD stage
Figure 2
Figure 2
Utilization of different antihypertension drug classes in different CKD stages. ACEI, angiotensin‐converting enzyme inhibitor; ARB, angiotensin receptor blocker; CCB, calcium channel blocker

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