Renal Function Alters Antihypertensive Regimens in Type 2 Diabetic Patients |
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| Authors: | Larry A. Weinrauch MD George Bayliss MD Alissa R. Segal Pharm D Jiankang Liu MD Eric Wisniewski John A. D'Elia MD |
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| Affiliation: | 1. Kidney and Hypertension Section, Joslin Diabetes Center, Boston, MA;2. Clinical End Points Section, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA;3. Division of Kidney Diseases and Hypertension, Rhode Island Hospital, Alpert Medical School, Brown University, Providence, RI |
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| Abstract: | To determine the prevalence of multidrug antihypertensive therapy (MDAT), records were evaluated for patients with both type 2 diabetes and hypertension during a 5‐year period at Joslin Diabetes Center. Hypertension control was defined as requiring multiple drugs if three or more antihypertensive drugs were used, one of which must be a diuretic (unless patient is receiving dialysis), or use of four or more antihypertensive drugs, one of which a diuretic (unless patient is receiving dialysis) was established. The objective was to determine the prevalence of multidrug requirement for hypertensive therapy in relationship to four levels of renal function estimated by the Modification of Diet in Renal Disease formula for glomerular filtration rate (GFR). Among 10,151 patients, mean estimated GFR was 80 mL/min. Using standard (ASN) classification for renal function, we noted the following breakdown of MDAT use: | Estimated GFR | Drugs, Mean No. | ≥3 Drugs, No. (%) | ≥4 Drugs, No. (%) | | <30 | 3.1 | 379 (67) | 214 (38) | | 30–60 | 2.7 | 1233 (55) | 538 (24) | | 60–90 | 2.0 | 1279 (33) | 458 (12) | | >90 | 1.5 | 600 (17) | 185 (5) | Prevalence of multidrug antihypertensive therapy is markedly increased in the presence of reduced renal function. |
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