Factors influencing level of blood pressure control in chronic kidney disease patients from Ilorin, Nigeria

Abstract

Background: The impact of recent guidelines recommending more aggressive BP control in patients with chronic kidney disease (CKD) is not known in our environment. We evaluated trends and predictors of BP control among our CKD patients with a view to determining factors influencing control in comparison with the results from other studies. Methods: Records of 179 CKD patients (120 males, 59 females) with mean age of 49.05΁15.48 years and male to female ratio of 2:1 were reviewed. Information on sociodemographic data, causes of CKD, blood pressure (BP) control and antihypertensive drug use were sought, categorized and recorded. CKD was defined as CFR less than 60ml/min per 1.73m\ while target treatment goal was taken as systolic and diastolic BP≤130mmHg and ≤80mmHg respectively. Results: Majority had isolated diastolic hypertension (53%) with few systolic hypertension (2%) while 27% had resistant hypertension and only 18% achieved target BP control. Pattern of drug use showed that 58% were compliant and the commonest drug combination (35%) was angiotensin receptor blocker (ARB), angiotensin converting enzyme inhibitor (ACEI), calcium channel blocker (CCB) and Diuretics. The use of multiple drugs including ARB and ACEI was associated with better control of BP. Conclusions: Uncontrolled hypertension was unacceptably high among our CKD patients using the newer control guidelines. Ignorance, poverty, advancing age, lack of treatment and poor compliance to treatment were associated with poor BP control. We recommend aggressive management including the use of three or more drugs at increasing doses especially in those having PKD and chronic glomerulonephritis (CGN) as aetiology. We also advocate health education with emphasis on compliance with medication in order to forestall socioeconomic burden of end stage renal disease.

Keywords

• CKD
• Blood Pressure Control
• Factors
• llorin
• Nigeria