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 OJNeph  Vol.4 No.1 , March 2014
Physician’s Awareness of Home Blood Pressure in the Treatment of Hypertensive Patients with Chronic Kidney Disease
Abstract: Aim: The majority of guidelines recommended the significance of home-based blood pressure (home-BP) measurement. The present study explored that to what extent, general practitioners (GPs) were aware of the importance of home-BP in the daily clinical practice. Method: We sent out questionnaires to GPs who had been specialized in nephrology and hypertension. The questions focused on the awareness of home-BP and the selections of antihypertensive agents for refractory hypertension in chronic kidney disease (CKD) patients. Results: 1) The majority (95.9%) of the responding GPs had utilized home-BP in their clinical practice. 2) When prescribing a single agent for hypertensive CKD patients, the majority of GPs (87.3%) chose ARB for the first line drug, and Ca channel blockers (CCB) were the second. 3) As an add-on drug to the pre-treatment with an angiotensin receptor blocker (ARB), the majority preferred CCB (82.7%) to diuretics (21.8%). In addition, a fixed combination formula of antihypertensive medication consisting of ARB plus diuretic was accepted by the majority of GPs (78.7%). 4) To improve morning hypertension in patients treated with two or more drugs, 87.8% of the doctors agreed that additional night-time dosing could be useful. The choices of the agents given at night-time varied, mainly with α1-blockers (40.6%), followed by α-blockers (30.5%) and α-methyldopa (19.8%). Conclusion: The majority of GPs in Japan are aware of the importance of the home-BP-based management of CKD. They mainly chose ARB as a first line drug, and ARB plus CCB as an add-on therapy.
Cite this paper: N. Sugano, S. Kuriyama, Y. Hara, K. Takane, Y. Takahashi, Y. Suetsugu and T. Yokoo, "Physician’s Awareness of Home Blood Pressure in the Treatment of Hypertensive Patients with Chronic Kidney Disease," Open Journal of Nephrology, Vol. 4 No. 1, 2014, pp. 28-36. doi: 10.4236/ojneph.2014.41005.
References

[1]   Jula, A., Puukka, P. and Karanko, H. (1999) Multiple Clinic and Home Blood Pressure Measurements versus Ambulatory Blood Pressure Monitoring. Hypertension, 34, 261-266. http://dx.doi.org/10.1161/01.HYP.34.2.261

[2]   Mancia, G., Parati, G., Hennig, M., Flatau, B., Omboni, S., Glavina, F., Costa, B., Scherz, R., Bond, G. and Zanchetti, A. (2001) For the ELSA Investigators. Relationship between Blood Pressure Variability and Carotid Artery Damage in Hypertension: Baseline Data from the European Lacidipine Study on Atherosclerosis (ELSA). Journal of Hypertension, 19, 1981-1989. http://dx.doi.org/10.1097/00004872-200111000-00008

[3]   Mancia, G. and Parati, G. (2000) Ambulatory Blood Pressure Monitoring and Organ Damage. Hypertension, 36, 894-900. http://dx.doi.org/10.1161/01.HYP.36.5.894

[4]   Mancia, G., Zanchetti, A., Agabiti-Rosei, E., Benemio, G., De Cesaris, R., Fogari, R., Pessina, A., Porcellati, C., Rappelli, A., Salvetti, A. and Trimarco, B. (1997) Ambulatory Blood Pressure Is Superior to Clinic Blood Pressure in Predicting Treatment Reduced Regression of Left Ventricular Hypertrophy. Circulation, 95, 1464-1470.
http://dx.doi.org/10.1161/01.CIR.95.6.1464

[5]   Khattar, R.S., Swales, J.D., Banfield, A., Dore, C., Senior, R. and Lahiri, A. (1999) Prediction of Coronary and Cerebrovascular Morbidity Blood Pressure Monitoring in Essential Hypertension. Circulation, 100, 1071-1076.
http://dx.doi.org/10.1161/01.CIR.100.10.1071

[6]   Lurbe, E., Redon, J., Kesani, A., Pascual, J.M., Tacons, J., Alvarez, V. and Batlle, D. (2002) Increase in Nocturnal Blood Pressure and Progression to Microalbuminuria in Type I Diabetes. The New England Journal of Medicine, 347, 797-805. http://dx.doi.org/10.1056/NEJMoa013410

[7]   Perloff, D., Sokolow, M. and Cowan, R. (1983) The Prognostic Value of Ambulatory Bloodpressures. JAMA, 249, 2793-2798. http://dx.doi.org/10.1001/jama.1983.03330440030027

[8]   Redon, J., Campos, C., Narciso, M.L., Rodicio, J.L., Pascual, J.M. and Ruilope, L.M. (1998) Prognostic Value of Ambulatory Blood Pressure Monitoring in Refractory Hypertension: A Prospective Study. Hypertension, 31, 712-718.
http://dx.doi.org/10.1161/01.HYP.31.2.712

[9]   Robinson, T.G., Dawson, S.L., Ahmed, U., Manktelow, B., Fotherby, M.D. and Potter, J.F. (2001) Twenty-Four Hour Systolic Blood Pressure Predicts Long-Term Mortality Following Acute Stroke. Journal of Hypertension, 19, 2127-2134. http://dx.doi.org/10.1097/00004872-200112000-00003

[10]   Staessen, J.A., Thijs, L., Fagard, R., O’Brien, E.T., Clement, D., de Leeuw, P.W., Mancia, G., Nachev, C., Palatini, P., Parati, G., Tuomilehto, J. and Webster, J. (1999) Predicting Cardiovascular Risk Using Conventional vs Ambulatory Blood Pressure in Older Patients with Systolic Hypertension: Systolic Hypertension in Europe Trial Investigators. JAMA, 282, 539-546. http://dx.doi.org/10.1001/jama.282.6.539

[11]   Bjorklund, K., Lind, L., Zethelius, B., Andren, B. and Lithell, H. (2003) Isolated Ambulatory hypertension Predicts Cardiovascular Morbidity in Elderly Men. Circulation, 107, 1297-1302.
http://dx.doi.org/10.1161/01.CIR.0000054622.45012.12

[12]   Clement, D.L., De Buyzere, M.L., De Bacquer, D.A., de Leeuw, P.W., Duprez, D.A., Fagard, R.H., Gheeraert, P.J., Missault, L.H., Braun, J.J., Six, R.O., Van Der Niepen, P. and O’Brien, E. (2003) For the Office Versus Ambulatory Pressure Study Investigators. Prognostic Value of Ambulatory Blood Pressure in Patients with Treated Hypertension. The New England Journal of Medicine, 348, 2407-2415. http://dx.doi.org/10.1056/NEJMoa022273

[13]   Verdecchia, P., Reboldi, G., Porcellati, C., Schillaci, G., Pede, S., Bentivoglio, M., Angeli, F., Norgiolini, S. and Ambrosio, G. (2002) Risk of Cardiovascular Disease in Relation to Achieved Office and Ambulatory Blood Pressure Control in Treated Hypertensive Subjects. Journal of the American College of Cardiology, 39, 878-885.
http://dx.doi.org/10.1016/S0735-1097(01)01827-7

[14]   Yamamoto, Y., Akiguchi, I., Oiwa, K., Hayashi, M. and Kimura, J. (1998) Adverse Effect of Nighttime Blood Pressure on the Outcome of Lacunar Infarct Patients. Stroke, 29, 570-576. http://dx.doi.org/10.1161/01.STR.29.3.570

[15]   Zweiker, R., Eber, B., Schumacher, M., Toplak, H. and Klein, W. (1994) “Non-Dipping” Related to Cardiovascular Events in Essential Hypertensive Patients. Acta Medica Austriaca, 21, 86-89.

[16]   Bobrie, G., Chatellier, G., Genes, N., Clerson, P., Vaur, L., Vaisse, B., Menard, J. and Mallion, J.M. (2004) Cardiovascular Prognosis of “Masked Hypertension” Detected by Blood Pressure Self-Measurement in Elderly Treated Hypertensive Patients. JAMA, 291, 1342-1349. http://dx.doi.org/10.1001/jama.291.11.1342

[17]   Kario, K., Pickering, T.G., Matsuo, T., Hoshide, S., Schwartz, J.E. and Shimada, K. (2001) Stroke Prognosis and Abnormal Nocturnal Blood Pressure Falls in Older Hypertensives. Hypertension, 38, 852-857.
http://dx.doi.org/10.1161/hy1001.092640

[18]   Sega, R., Facchetti, R., Bombelli, M., Cesana, G., Corrao, G., Grassi, G. and Mancia, G. (2005) Prognostic Value of Ambulatory and Home Blood Pressures Compared with Office Blood Pressure in General Population. Circulation, 111, 1777-1783. http://dx.doi.org/10.1161/01.CIR.0000160923.04524.5B

[19]   Verdecchia, P., Porcellati, C., Schillaci, G., Borgioni, C., Ciucci, A., Battistelli, M., Guerrieri, M., Gatteschi, C., Zampi, I. and Santucci, A. (1994) Ambulatory Blood Pressure: An Independent Predictor of Prognosis in Essential Hypertension. Hypertension, 24, 793-801. http://dx.doi.org/10.1161/01.HYP.24.6.793

[20]   Martinez, M.A., Sancho, T., Garcia, P., Moreno, P., Rubio, J.M., Palau, F.J., Anton, J.L., Cirujano, F.J., Sanz, J., Puig, J.G. and MAPA Working Group (2006) Home Blood Pressure in Poorly Controlled Hypertension: Relationship with Ambulatory Blood Pressure and Organ Damage. Blood Pressure Monitoring, 11, 207-213.
http://dx.doi.org/10.1097/01.mbp.0000209073.30708.e1

[21]   Mule, G., Caimi, G., Cottone, S., Nardi, E., Andronico, G., Piazza, G., Volpe, V., Federico, M.R. and Cerasola, G. (2002) Value of Home Blood Pressures as Predictor of Target Organ Damage in Mild Arterial Hypertension. Journal of Cardiovascular Risk, 9, 123-129. http://dx.doi.org/10.1097/00043798-200204000-00008

[22]   Stergiou, G.S., Argyraki, K.K., Moyssakis, I., Mastorantonakis, S.E., Achimastos, A.D., Karamanos, V.G. and Roussias, L.G. (2007) Home Blood Pressure Is as Reliable as Ambulatory Blood Pressure in Predicting Target-Organ Damage in Hypertension. American Journal of Hypertension, 20, 616-621.
http://dx.doi.org/10.1016/j.amjhyper.2006.12.013

[23]   Mancia, G., De Backer, G., Dominiczak, A., Cifkova, R., Fagard, R., Germano, G., Grassi, G., Heagerty, A.M., Kjeldsen, S.E., Laurent, S., Narkiewicz, K., Ruilope, L., Rynkiewicz, A., Schmieder, R.E., Boudier, H.A. and Zanchetti, A. (2007) Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Journal of Hypertension, 25, 1105-1187. http://dx.doi.org/10.1097/HJH.0b013e3281fc975a

[24]   Parati, G., Stergiou, G.S., Asmar, R., Bilo G, de Leeuw, P., Imai, Y., Kario, K., Lurbe, E., Manolis, A., Mengden, T., O’Brien, E., Ohkubo, T., Padfield, P., Palatini, P., Pickering, T.G., Redon, J., Revera, M., Ruilope, L.M., Shennan, A., Staessen, J.A., Tisler, A., Waeber, B., Zanchetti, A., Mancia, G. and On Behalf of ESH Working Group on Blood Pressure Monitoring (2010) European Society of Hypertension Practice Guidelines for Home Blood Pressure Monitoring. Journal of Human Hypertension, 24, 779-785. http://dx.doi.org/10.1038/jhh.2010.54

[25]   Verdecchia, P., Angeli, F., Mazzatta, G., Gentile, G. and Reboldi, G. (2009) Home Blood Pressure Measurement Will Not Replace 24-Hour Ambulatory Blood Pressure Monitoring. Hypertension, 54, 188-195.
http://dx.doi.org/10.1161/HYPERTENSIONAHA.108.122861

[26]   Kobayashi, M., Obara, T., Ohkubo, T., Fukunaga, H., Satoh, M., Metoki, H., Asayama, K., Inoue, R., Kikuya, M., Mano, N., Miyakawa, M. and Imai, Y. (2010) Practice and Awareness of Physicians Regarding Casual-Clinic Blood Pressure Measurement in Japan. Hypertension Research, 33, 960-964. http://dx.doi.org/10.1038/hr.2010.89

[27]   Obara, T., Ohkubo, T., Fukunaga, H., Kobayashi, M., Satoh, M., Metoki, H., Asayama, K., Inoue, R., Kikuya, M., Mano, N., Miyakawa, M. and Imai, Y. (2010) Practice and Awareness of Physicians Regarding Home Blood Pressure Measurement in Japan. Hypertension Research, 33, 428-434. http://dx.doi.org/10.1038/hr.2010.10

[28]   Elliot, W.J. (2002) Is Fixed Combination Therapy Appropriate for Initial Hypertension Treatment? Current Hypertension Reports, 4, 278-285. http://dx.doi.org/10.1007/s11906-996-0005-z

[29]   Black, H.R. (2009) Triple Fixed-Dose Combination Therapy. Hypertension, 54, 19-22.
http://dx.doi.org/10.1161/HYPERTENSIONAHA.109.132688

[30]   Ogihara, T., Kikuchi, K., Matsuoka, H., Fujita, T., Higaki, J., Horiuchi, M., Imai, Y., Imaizumi, T., Ito, S., Iwao, H., Kario, K., Kawano, Y., Kim-Mitsuyama, S., Kimura, G., Matsubara, H., Matsuura, H., Naruse, M., Saito, I., Shimada, K., Shimamoto, K., Suzuki, H., Takishita, S., Tanahashi, N., Tsuchihashi, T., Uchiyama, M., Ueda, S., Ueshima, H., Umemura, S., Ishimitsu, T., Rakugi, H. and Japanese Society of Hypertension Committee. (2009) The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2009). Hypertension Research, 32, 103-107.

[31]   Chobanian, A.V., Bakris, G.L., Black, H.R., Cushman, W.C., Green, L.A., Izzo Jr., J.L., Jones, D.W., Materson, B.J., Oparil, S., Wright Jr., J.T., Roccella, E.J. and Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (2003) National Heart, Lung, and Blood Institute; National High Blood Pressure Education Program Coordinating Committee. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension, 42, 1206-1252.
http://dx.doi.org/10.1161/01.HYP.0000107251.49515.c2

[32]   Kohro, T., Yamazaki, T., Sato, H., Ohe, K. and Nagai, R. (2013) The Impact of a Change in Hypertension Management Guidelines on Diuretic Use in Japan: Trend in Antihypertensive Drug Prescriptions from 2005 to 2011. Hypertension Research, 36, 559-563. http://dx.doi.org/10.1038/hr.2012.216

[33]   Kario, K., Pickering, T.G., Hoshide, S., Eguchi, K., Ishikawa, J., Morinari, M., Hoshide, Y. and Shimada, K. (2004) Morning Blood Pressure Surge and Hypertensive Cerebrovascular Disease. American Journal of Hypertension, 17, 668-675. http://dx.doi.org/10.1016/j.amjhyper.2004.04.001

[34]   Kario, K., Schwartz, J.E. and Pickering, T.G. (2000) Changes of Nocturnal Blood Pressure Dipping Status in Hypertensives by Nighttime Dosing of α-Adrenergic Blocker, Doxazosin. Result from HALT Study. Hypertension, 35, 787-794. http://dx.doi.org/10.1161/01.HYP.35.3.787

[35]   Hermida, R.C., Ayala, D.E., Fernamdez, J.R. and Calvo, C. (2007) Comparison of the Efficacy of Morning versus Evening Administration of Telmisartan in Essential Hypertension. Hypertension, 50, 715-722.
http://dx.doi.org/10.1161/HYPERTENSIONAHA.107.094235

[36]   Hermida, R.C., Ayala, D.E., Smolensky, M.H. and Portaluppi, F. (2007) Chronotherapy in Hypertensive Patients: Administration Time Dependent Effects of Treatment on Blood Pressure Regulation. Expert Review of Cardiovascular Therapy, 5, 463-475. http://dx.doi.org/10.1586/14779072.5.3.463

[37]   Hermida, R.C. and Ayala, D.E. (2009) Chronotherapy with the Angiotensin-Converting Enzyme Inhibitor Ramipril in Essential Hypertension: Improved Blood Pressure Control with Bedtime Dosing. Hypertension, 54, 40-46.
http://dx.doi.org/10.1161/HYPERTENSIONAHA.109.130203

[38]   Hermida, R.C., Ayala, D.E., SCalvo, C., Portaluppi, F. and Smolensky, M.H. (2007) Chronotherpy of Hypertension: Administration-Time-Dependent Effects of Treatment on the Circadian Pattern of Blood Pressure. Advanced Drug Delivery Review, 59, 923-939. http://dx.doi.org/10.1016/j.addr.2006.09.021

 
 
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