The Use of Antihypertensive Drugs in Pre-Dialysis Chronic Kidney Disease Patients

Budi Suprapti, Mochammad Thaha, Wenny Putri Nilamsari, Ihsan Muhyidin, Vini Siane Tanaem, Euphrasiane Griseldis Beting

Abstract


In chronic kidney disease (CKD), hypertension plays a central role, acting as both a risk factor and a complication that contributes to disease progression. Effective control of blood pressure through antihypertensive therapy is essential for preserving kidney function and preventing clinical decline. Therefore, this study aimed to evaluate antihypertensive treatment and blood pressure target achievement in pre-dialysis CKD patients, with blood pressure targets defined as <130/80 mmHg and <140/80 mmHg in elderly patients. This study was a prospective observational study with a retrospective review of medical records over a 3-month period, and the data were subsequently analyzed using descriptive methods. Participants were pre-dialysis CKD patients aged 18 or older receiving antihypertensive therapy with complete blood pressure records. Among the 90 eligible patients, the most commonly used antihypertensive classes were angiotensin receptor blockers, particularly candesartan, and calcium channel blockers, specifically nifedipine, either as monotherapy or combined with two to five other antihypertensive drugs. Over three months, only an average of 23.3% of patients achieved blood pressure targets, and only 8.9% maintained that continuously. Therefore, a more effective blood pressure management strategy is needed to achieve the desired target blood pressure.

Keywords


Chronic kidney disease; Pre-dialysis; Hypertension; Antihypertensive; Blood pressure

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References


P. E. Stevens et al., “KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease,” Kidney Int., vol. 105, no. 4, pp. S117–S314, 2024, [Online]. Available: https://doi.org/https://doi.org/10.1016/j.kint.2023.10.018

M. A. Alsalloum, M. A. Albekery, and I. S. Alhomoud, “Management of hypertension in chronic kidney disease: current perspectives and therapeutic strategies,” Front. Med., vol. 12, pp. 1–11, 2025, [Online]. Available: https://doi.org/10.3389/fmed.2025.1630160

A. E. Ahmed et al., “Effect of Blood Pressure Control on Cardiovascular Events in Patients with Chronic Kidney Disease: A Systematic Review,” Cureus, vol. 2, no. 6, pp. 4–11, 2025, [Online]. Available: https://doi.org/10.7759/cureus.86230

T. Unger et al., “2020 International Society of Hypertension Global Hypertension Practice Guidelines,” Hypertension, vol. 75, no. 6, pp. 1334–1357, 2020, [Online]. Available: https://doi.org/10.1161/HYPERTENSIONAHA.120.15026

T. Geng et al., “Relationship Between Control of Cardiovascular Risk Factors and Chronic Kidney Disease Progression, Cardiovascular Disease Events, and Mortality in Chinese Adults,” J. Am. Coll. Cardiol., vol. 84, no. 14, pp. 1313–1324, 2024, [Online]. Available: https://doi.org/10.1016/j.jacc.2024.06.041

J. J. Chen et al., “Impact of Different Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blocker Resumption Timing on Post Acute Kidney Injury Outcomes,” Kidney Int. Reports, vol. 9, no. 11, pp. 3290–3300, 2024, [Online]. Available: https://doi.org/10.1016/j.ekir.2024.08.027

J. Zhang et al., “Blood pressure management in hypertensive people with non-dialysis chronic kidney disease in Queensland, Australia,” BMC Nephrol., vol. 20, no. 1, p. 348, 2019, [Online]. Available: https://doi.org/10.1186/s12882-019-1532-6

M. Weldegiorgis and M. Woodward, “The impact of hypertension on chronic kidney disease and end-stage renal disease is greater in men than women: a systematic review and meta-analysis,” BMC Nephrol., vol. 21, no. 1, p. 506, 2020, [Online]. Available: https://doi.org/10.1186/s12882-020-02151-7

K. Qin, J. Qing, Q. Wang, and Y. Li, “Epidemiological shifts in chronic kidney disease: a 30-year global and regional assessment,” BMC Public Health, vol. 24, no. 1, p. 3519, 2024, [Online]. Available: https://doi.org/10.1186/s12889-024-21065-9

Y. Jiang et al., “Age and estimated glomerular filtration rate in Chinese older adults: a cohort study from 2014 to 2020,” Front. Public Heal., vol. 12, pp. 1–8, 2024, [Online]. Available: https://doi.org/10.3389/fpubh.2024.1392903

K. F. Qureshi, Y. Patil, and P. Rajput, “Risk Factors of Chronic Kidney Diseases: A Retrospective, Record based Study from a Tertiary Care Hospital in India,” Prev. Med. Res. Rev., vol. 2, no. 3, pp. 102–106, 2025, [Online]. Available: https://doi.org/10.4103/pmrr.pmrr_94_24

H. Lee, S. H. Kwon, J. S. Jeon, H. Noh, D. C. Han, and H. Kim, “Association between blood pressure and the risk of chronic kidney disease in treatment-naïve hypertensive patients,” Kidney Res. Clin. Pract., vol. 41, no. 1, pp. 31–42, 2022, [Online]. Available: https://doi.org/10.23876/j.krcp.21.099

X. Lu et al., “Association Between Age of Onset of Hypertension and Risk of CKD Cohort Study Based on the UK Biobank,” Kidney360, vol. 6, no. 10, pp. 1702–1712, 2025, [Online]. Available: https://doi.org/10.34067/KID.0000000872

L. Jin, X. Wang, Y. Liu, Q. Xiang, and R. Huang, “High levels of blood glycemic indicators are associated with chronic kidney disease prevalence in non-diabetic adults: Cross-sectional data from the national health and nutrition examination survey 2005–2016,” J. Clin. Transl. Endocrinol., vol. 36, p. 100347, 2024, [Online]. Available: https://doi.org/10.1016/j.jcte.2024.100347

M. A. Alshehri et al., “Prevalence of chronic kidney disease in Saudi Arabia: an epidemiological population-based study,” BMC Nephrol., vol. 26, no. 1, p. 37, 2025, [Online]. Available: https://doi.org/10.1186/s12882-025-03954-2

N. M. Hustrini et al., “Prevalence, incidence and risk factors of chronic kidney disease in people with diabetes and hypertension, and the prognosis and kidney function decline in Indonesia: a multicentre cross-sectional study in primary care centres,” BMJ Open, vol. 15, no. 10, p. e103779, 2025, [Online]. Available: https://doi.org/10.1136/bmjopen-2025-103779

P. C. Dattolo et al., “Conservative management of chronic kidney disease stage 5: role of angiotensin converting enzyme inhibitors,” J. Nephrol., vol. 29, no. 6, pp. 809–815, 2016, [Online]. Available: https://doi.org/10.1007/s40620-016-0290-9

R. E. Schmieder, “2025 Update on resistant hypertension in CKD: where do we stand and where do we go?,” Clin. Kidney J., vol. 18, no. Supplement_2, pp. ii10–ii16, 2025, [Online]. Available: https://doi.org/10.1093/ckj/sfaf285

R. Chinnadurai et al., “Antihypertensive prescribing patterns in non-dialysis dependent chronic kidney disease: Findings from the Salford Kidney Study,” World J. Nephrol., vol. 12, no. 5, pp. 168–181, 2023, [Online]. Available: https://doi.org/10.5527/wjn.v12.i5.168

B. Liu, Q. Wang, Y. Wang, J. Wang, L. Zhang, and M. Zhao, “Utilization of antihypertensive drugs among chronic kidney disease patients: Results from the Chinese cohort study of chronic kidney disease (C-STRIDE),” J. Clin. Hypertens., vol. 22, no. 1, pp. 57–64, 2020, [Online]. Available: https://doi.org/10.1111/jch.13761

O. M. Oladimeji et al., “Antihypertensive prescription pattern and determinants of blood pressure control among chronic kidney disease patients,” Glob. Transl. Med., vol. 4, no. 4, p. 81, 2025, [Online]. Available: https://doi.org/10.36922/gtm025130032

F. Li, A. Sun, F. Wu, D. Zhang, and Z. Zhao, “Trends in using of antihypertensive medication among US CKD adults, NHANES 2001–2018,” Front. Cardiovasc. Med., vol. 10, pp. 1–10, 2023, [Online]. Available: https://doi.org/10.3389/fcvm.2023.990997

C. G. Derington et al., “Trends in Antihypertensive Medication Monotherapy and Combination Use Among US Adults, National Health and Nutrition Examination Survey 2005-2016,” Hypertension, vol. 75, no. 4, pp. 973–981, 2020, [Online]. Available: https://doi.org/10.1161/HYPERTENSIONAHA.119.14360

C. Mancusi et al., “Determinants of decline of renal function in treated hypertensive patients: The Campania Salute Network,” Nephrol. Dial. Transplant., vol. 33, no. 3, pp. 435–440, 2018, [Online]. Available: https://doi.org/10.1093/ndt/gfx062

D. D. Katatwire and A. Meremo, “Prevalence of and factors associated with uncontrolled hypertension among patients with early chronic kidney disease attending tertiary hospitals in Dodoma, Tanzania: A cross-sectional study,” BMJ Open, vol. 13, no. 12, p. e074441, 2023, [Online]. Available: https://doi.org/10.1136/bmjopen-2023-074441

S. Kaul, A. Ahsan, N. P. Singh, D. Khullar, and A. K. Gupta, “Evaluation of Medication Adherence in Chronic Kidney Disease Patients with and without Hemodialysis,” Indian J. Med. Spec., vol. 14, no. 3, pp. 162–167, 2023, [Online]. Available: https://doi.org/10.4103/injms.injms_46_23

Y. Cui et al., “Development and Validation of the Treatment Adherence Scale for Non-Dialysis Chronic Kidney Disease Patients in China: A Mixed-Methods Study,” Patient Prefer. Adherence, vol. 20, pp. 1–17, 2026, [Online]. Available: https://doi.org/10.2147/PPA.S573282

T. P. Elias, A. T. Minyilshewa, M. A. Tekle, T. W. Gebreamlak, and B. L. Adde, “Predictors of Antihypertensive Drug Adherence and Blood Pressure Control Among Hypertensive Patients: A Multicenter Cross-Sectional Study,” Int. J. Hypertens., vol. 2025, no. 1, 2025, [Online]. Available: https://doi.org/10.1155/ijhy/1055517




DOI: https://doi.org/10.37311/ijpe.v6i2.38102

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