Treatment of Hypertension in Italian Nephrology Out-patient Clinics: The THIN Study

Optimal pressure control is crucial to prevent cardiovascular events in hypertensive patients. However, well-controlled blood pressure is encountered only in a small percentage of hypertensive patients managed by general practitioners, cardiologists, diabetologists, and hypertension specialists. This study aimed to evaluate the target of blood pressure obtained in Italian nephrology out-patient clinics. Data were collected by questionnaire sent to nephrology out-clinics. Questions were pertinent to patient's clinical characteristics, lifestyle, biochemistry, blood pressure at the first and last visit, and antihypertensive medications. Data pertinent to 1,632 patients were collected. More frequent causes of hypertension were essential hypertension (26%), hypertension secondary to renal insufficiency (16%), and diabetes (10%). At admission the systolic blood pressure was more than 140 mm Hg in 98% and diastolic blood pressure was more than 90 mm Hg in 95% of patients; at the last visit a normalized systolic and diastolic blood pressure was found in 38% and in 75% of patients. A higher normalization rate was achieved in essential hypertensive patients compared with patients with hypertension secondary to chronic renal insufficiency and diabetes. These data indicate that improvement is obtained by nephrologists in controlling essential hypertension although more effective strategies in the management of hypertension in patients with reduced renal function and in diabetic patients still are required.