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Kidney Week

Abstract: PO2089

Individualized Hypertension Management in CKD

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Chait, Yossi, University of Massachusetts Amherst, Amherst, Massachusetts, United States
  • Nathanson, Brian Harris, OptiStatim, LLC,, Longmeadow, Massachusetts, United States
  • Greco, Barbara A., Renal and Transplant Associates of New England, Springfield, Massachusetts, United States
  • Germain, Michael J., Renal and Transplant Associates of New England, Springfield, Massachusetts, United States
Background

The prevalence of hypertension (HTN) in chronic kidney disease (CKD) patients ranges from 60% to 90% with up to 50% having drug resistant hypertension.

Methods

We instituted a practice improvement project comparing hypertension Standard Care (Group B) to an Individualized Protocol (Group A) in non-dialysis CKD patients referred to our nephrology practice. The Individualized Protocol used noninvasive impedance cardiography (NICAS) and central arterial pressure waveform analysis (SphygmoCor) to define the hemodynamic state: vasoconstricted, hyperdynamic, or mixed. Recommendations for pharmacologic interventions were guided by the hemodynamic state, however, choice of specific drugs was left to the nephrologist. Group A nephrologists were trained to use the Individualized Protocol, and hypertensive patients were assigned to groups A or B during an initial 6-month period, then followed for 6 months (endpoint).

Results

There were 90 and 21 patients in groups A and B, respectively. At baseline, demographics were similar in both groups (Table 1). At endpoint, Group A had more patients at targeted blood pressure (BP) (55.6% vs 33.3% at 140/90 mmHg; 21.1% vs 19% at 130/80 mmHg), and larger reduction in both brachial and central BP parameters (Table 2). The mean (SD) of number of office visits were 3.1(1.0) and 2.9(1.1), in Groups A and B, respectively. In Group A, mean aorta compliance was increased 23.3% and 1.7% in the subgroups that met and did not meet target BP, respectively. Mean number of medications at baseline/endpoint were 1.7/2.6 and 1.9/2.0 in groups A and B, respectively. At endpoint, Group B had negligible change in distribution of drug classes, while Group A had significant increased use of calcium channel blockers (dihydropyridine) and beta-blockers.

Conclusion

Impedance cardiography is a simple, noninvasive method for evaluating underlying hemodynamic drivers of HTN. Hypertension management is more effective when guided by hemodynamic state.

Table 1

Table 2