Management of patients with hypertension and chronic kidney disease referred to Hypertension Excellence Centres among 27 countries. On behalf of the European Society of Hypertension Working Group on Hypertension and the Kidney

• Authors: HALIMI Jean-Michel; SARAFIDIS Pantelis; AZIZI Michel; BILO Grzegorz; BURKARD Thilo; BURSZTYN Michael; CAMAFORT Miguel; CHAPMAN Neil; COTTONE Santina; TINE de Backer; DEINUM Jaap; DELMOTTE Philippe; DOROBANTU Maria; DOUMAS Michalis; DUSING Rainer; DULY-BOUHANICK Beatrice; FAUVEL Jean-Pierre; FESLER Pierre; GACIONG Zbigniew; GKALIAGKOUSI Eugenia; GORDIN Daniel; GRASSI Guido; GRASSOS Charalampos; GUERROT Dominique; HUART Justine; IZZO Raffaele; AGUILA Fernando Jaen; JARAI Zoltan; KAHAN Thomas; KANTOLA Ilkka; KOCIANOVA Eva; LIMBOURG FlorianP; LOPEZ-SUBLET Marilucy; MALLAMACI Francesca; MANOLIS Athanasios; MARKETOU Maria; MAYER Gert; MAZZA Alberto; MACINTYRE IainM; MOURAD Jean-Jacques; MUIESAN Maria Lorenza; NASR Edgar; NILSSON Peter; OLIVERAS Anna; ORMEZZANO Olivier; PAIXAO-DIAS Vitor; PAPADAKIS Ioannis; PAPADOPOULOS Dimitris; PERL Sabine; POLONIA Jorge; PONTREMOLI Roberto; PUCCI Giacomo; ROBLES Nicolas Roberto; RUBIN Sebastien; RUILOPE Luis Miguel; RUMP Lars Christian; SAEED Sahrai; SANIDAS Elias; SARZANI Riccardo; SCHMIEDER Roland; SILHOL Francois; SOKOLOVIC Sekib; SOLBU Marit; SOUCEK Miroslav; STERGIOU George; SUDANO Isabella; TABBALAT Ramzi; TENGIZ Istemihan; TRIANTAFYLLIDI Helen; TSIOUFIS Konstontinos; VACLAVIK Jan; MARKUS van der Giet; PATRICIA Van der Niepen; VEGLIO Franco; VENZIN RetoM; VIIGIMAA Margus; WEBER Thomas; WIDIMSKY Jiri; WUERZNER Gregoire; ZELVEIAN Parounak; ZEBEKAKIS Pantelis; LUEDERS Stephan; PERSU Alexandre; KREUTZ Reinhold; VOGT Liffert
• Year of publication: 2024
• Type: Article in Periodical
• Magazine / Source: Blood Pressure
• MU Faculty or unit: Faculty of Medicine
• web: https://www.tandfonline.com/doi/full/10.1080/08037051.2024.2368800
• Doi: http://dx.doi.org/10.1080/08037051.2024.2368800
• Keywords: Chronic kidney disease; hypertension; management; RAS blockers; hyperkalaemia; SGLT2 inhibitors; mineralocorticoid receptor antagonists; guidelines
• Description: Objective Real-life management of patients with hypertension and chronic kidney disease (CKD) among European Society of Hypertension Excellence Centres (ESH-ECs) is unclear : we aimed to investigate it. Methods A survey was conducted in 2023. The questionnaire contained 64 questions asking ESH-ECs representatives to estimate how patients with CKD are managed. Results Overall, 88 ESH-ECS representatives from 27 countries participated. According to the responders, renin-angiotensin system (RAS) blockers, calcium-channel blockers and thiazides were often added when these medications were lacking in CKD patients, but physicians were more prone to initiate RAS blockers (90% [interquartile range: 70-95%]) than MRA (20% [10-30%]), SGLT2i (30% [20-50%]) or (GLP1-RA (10% [5-15%]). Despite treatment optimisation, 30% of responders indicated that hypertension remained uncontrolled (30% (15-40%) vs 18% [10%-25%]) in CKD and CKD patients, respectively). Hyperkalemia was the most frequent barrier to initiate RAS blockers, and dosage reduction was considered in 45% of responders when kalaemia was 5.5-5.9 mmol/L. Conclusions RAS blockers are initiated in most ESH-ECS in CKD patients, but MRA and SGLT2i initiations are less frequent. Hyperkalemia was the main barrier for initiation or adequate dosing of RAS blockade, and RAS blockers' dosage reduction was the usual management.