Patients with end-stage kidney disease (ESKD) are considered the highest risk group for cardiovascular disease. Hypertension is prevalent in this patient population. Our goal was to study baseline blood pressure and its treatment in patients with ESKD referred for cardiovascular evaluation prior to possible renal transplantation.
Data from patient records were collected retrospectively on 179 patients who underwent pre-operative cardiac evaluation for kidney transplant. Baseline demographics, blood pressure, and antihypertensive treatment obtained in the initial clinic visit were recorded.
The patient population was 64% male. Mean patient age was 50 ± 12 years. Sixty-five percent had diabetes, and 97% were receiving medical treatment for hypertension. Thirty-five percent had known coronary artery disease at baseline. For all patients evaluated, mean systolic blood pressure was 144 ± 26 mm Hg, mean diastolic blood pressure was 77 ± 14 mm Hg, and mean pulse pressure was 67 ± 21 mm Hg. For patients with diabetes, mean systolic blood pressure was 145 ± 26 mm Hg; only 26% of these patients had systolic blood pressures less than 130 mm Hg. The mean number of antihypertensive medications per patient was 2.3. Of patients taking various combinations of antihypertensive medications, 51% were taking either angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), 49% were taking beta blockers, 52% were taking calcium channel blockers, and 26% were taking diuretics.CONCLUSIONS: A high percentage of potential candidates for kidney transplantation with diabetes and hypertension have poorly controlled systolic blood pressure inconsistent with current national treatment guidelines. Only half of these high risk patients are on ACE inhibitors or ARBs which have demonstrated benefits in reducing cardiovascular morbidity and mortality.
More aggressive blood pressure reduction is needed for patients with hypertension, diabetes, and ESKD. The combination of antihypertensive agents required to achieve this should include greater use of ACE inhibitors and ARBs which have been shown to reduce cardiovascular events and mortality in this high risk population.
P.J. Chaille, None.