Zdravniški Vestnik (Sep 2007)
Is arterial hypertension of patients with IgA nephropathy well controlled?
Abstract
Background: Next to proteinuria, serum creatinine level, age and histopathological changes arterial hypertension (AH) is represents an important risk factor of kidney disease progression in patients with chronic kidney disease. The purpose of the present study was to assess the prevalence, treatment and control of AH in patients with IgA nephropathy (IgAN) according to Slovenian guidelines.Methods: One hundred and ten patients with IgAN, hospitalized at Department of Nephrology in University Medical Center Ljubljana between January 2002 and December 2006, were enrolled in our retrospective study. Clinical data including systolic, diastolic blood pressure the day before renal biopsy, sex, age, family history of hypertension, 24-hour proteinuria and serum creatinine level were evaluated from medical documentation. The glomerular filtration rate was estimated by measured creatinine clearance, Cockcroft-Gault and MDRD Study equation. The number and the dose of antihypertensive drugs before renal biopsy and on the discharge were registered.Results: Twenty-three (20.9 %) patients with IgAN were normotensive. 87 (79.1 %) patients had AH, among them only 13 (14.9 %) had blood pressure lower than 130/80 mm Hg. Patients with AH were older (p = 0.001), with higher 24-hour proteinuria (p < 0.002), serum creatinine level (p < 0.001), lower creatinine clearance (p < 0.004) and had more often family history of hypertension (p = 0.05). Before renal biopsy patients were treated with 0 to 4 antihypertensive drugs, on discharge from 1 to 6, among them number of angiotensinconverting enzyme inhibitors (ACEi) and angiotensin receptor antagonist (ARB) were increased (from 65.5 % to 80.4 %).Conclusions: Ninety-seven percent of patients with IgAN had AH which was treated according to Slovenian guidelines in less than 15 %. The choice of ACEi and ARB drug groups was adequate, but the number and the dose of drugs should be increased for well-controlled blood pressure.
