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Q J Med 1999; 92: 519-525
© 1999 Association of Physicians

Management of hypertension in patients developing end-stage renal failure

I. Dasgupta, R.J. Madeley1, M.A.L. Pringle1, J. Savill2 and R.P. Burden

From the Renal Unit, Nottingham City Hospital, and the 1 School of Community Health Sciences and 2 School of Medical and Surgical Sciences, University of Nottingham, Nottingham, UK

Received 15 April 1999 and in revised form 5 July 1999

Dr R.P. Burden, Renal Unit, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB

The benefits of treating hypertension include preventing or delaying the progression of chronic renal failure, and reducing the cardiovascular complications of patients with renal disease. We examined how well hypertension had been managed in all 145 patients from a single health district who started dialysis during a 3-year period. Data relating to management of hypertension, including all blood pressure readings, were obtained from their general practice and hospital case notes. The anonymized data were reviewed by two independent assessors against a set of standards based on the British Hypertension Society guidelines. There was close agreement between the assessors. Complete records were obtained in 98.5% of cases. Of the 145 patients, 107 (76.4%) were hypertensive before developing end-stage renal failure. There were departures from standards in all categories of care: 24.3% in detection/diagnosis, 29% in investigation, 22.4% in referring to a nephrologist, and 17% in follow-up. The British Hypertension Society recommended standard for diastolic blood pressure of 90 mmHg was achieved in only 45%. In 32%, the assessors independently concluded that poor blood pressure control might have affected adversely the progression of renal failure. New methods of dealing with these problems are required and possible approaches are discussed.


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