RESEARCHERS at the University of Limerick have found that the management and control of high blood pressure in people with chronic kidney disease (CKD) is “poor”.
This comes as a warning for the approximately 400,000 Irish adults suffering from the condition, given that high blood pressure and hypertension come with the increased risk of kidney failure, heart attacks, and strokes.
The University of Limerick researchers (UL) also found that four in five, or 82 per cent, of people living with CKD over 50 suffer from hypertension. While less than half are managing to control it effectively.
Key findings from the UL study, the largest and most comprehensive of its kind in Ireland and published in the Clinical Kidney Journal, also show that while there is an increased awareness of hypertension and high blood pressure among CKD patients (compared to those without the condition who also have high blood pressure), only 49.3 per cent are managing to reach the recommended blood pressure target of under 140/90 mmHg.
In adults over the age of 75, this figure dropped to 42.4 per cent.
“Despite our best efforts using a wide variety of anti-hypertensive medications, achievement of blood pressure control in patients with kidney disease remains a major challenge,” said Dr Leonard Browne, leading scientist in charge of the study.
“Our findings are in line with international studies and reveal that while there are high levels of awareness of hypertension, and high rates of treatment compared to individuals without kidney disease, we are not getting patients to desired targets associated with the best outcomes.”
“62 per cent of individuals with hypertension were receiving two or more antihypertensive medications, and this number reached 67 per cent in those age 75 and over.”
According to Dr Browne, many patients too aren’t receiving the full treatment they might need to help control their hypertension – despite two thirds of CKD patients receiving two or more anti-hypertensive medications – and that an increase in medication is “often a necessary step in these patients to ensure more effective blood pressure control along with lifestyle modification”.
Dr Browne and Professor Austin Stack highlighted the difficulties in maintaining optimal blood pressure control despite the widespread availability of treatments, suggesting a number of factors outside of the medical space may be at play too.
“Non-adherence to medication is common among many patients, which may partially explain these findings,” Dr Browne said. “Additionally, some doctors may hesitate to prescribe additional blood pressure medications due to concerns about overtreatment, higher risk of falls, and ongoing controversy over blood pressure targets.”
Dr Angie Brown of the Irish Heart Foundation and Ms Carol Moore of the Irish Kidney Association both touted the importance of the study’s findings, noting not only the cost to Irish health but also to the Irish wallet as it costs an average of €125,000 per year to provide dialysis to a single patient.
“We already knew that hypertension is common and severe in patients with kidney disease, which leads to higher rates of kidney failure requiring dialysis, and major cardiovascular events like heart attacks and strokes. Better control of blood pressure will reduce these risks and prevent a considerable amount of suffering,” added Professor George Mellotte, director of the National Renal Office (NRO) and consultant nephrologist.
