Sweileh WM, Sawalha AF, Zyoud SH, Al-Jabi SW, Tameem EJ. Patterns of Antihypertensive Therapy in Diabetic Patients with and without Reduced Renal Function. Accepted for publish at Saudi Journal of Kidney Diseases and Transplantation (SJKDT)(2010) [Publisher: Saudi Center for Organ Transplantation, Country where published: Saudi Arabia]. In press. 

Abstract 

Background: Renal deterioration is a common complication in patients with diabetes mellitus and hypertension. Appropriate use of antihypertensive agents and tight control of blood pressure (BP) can minimize and delay such complications. Objective: To investigate the utilization patterns of antihypertensive agents and to evaluate blood pressure control among diabetic hypertensive patients with and without reduced renal function. Methodology: Retrospective cohort study. All diabetic hypertensive patients attending Al-Watani medical governmental center from August 01, 2006 until August 01, 2007 were considered in the study. Patients with a history of congestive heart failure and/or end stage renal disease were excluded. Proportions of use of 5 different antihypertensive drug classes were compared for all patients receiving 1, 2, 3, or 4 drugs, and separately among patients with and without reduced renal function. Results: Over 60% of patients were receiving angiotensin-converting enzyme inhibitors (ACEI)/ angiotensin receptor blocker (ARB), followed by diuretics (40.8%), calcium channel blockers (25.1%) and β-blockers (12.5%). The majority (> 55%) of patients were either on mono or no drug therapy. Patients on monotherapy were mostly receiving ACEI/ARB (60%). In patients with reduced renal function, use of diuretics but not ACEI/ARB or CCB was higher and 41.8% of the patients were on monotherapy compared to 46.6% in patients with normal renal function. The proportions of patients achieving BP control were 20% and 28% for patients on monotherapy versus those on combination therapy respectively. Conclusions: Patterns of antihypertensive therapy were generally but not adequately consistent with international guidelines. Areas of improvement include increasing ACEI/ARB and diuretic use, decreasing the number of untreated patients, and increasing the proportion of patients with controlled BP in this population.