Baseline characteristics and antihypertensive patterns in Finnish patients with hypertension and kidney disease
T Niiranen, M Summanen, T Miettinen, C Asseburg, P Finne, D GordinAbstract
Background
Chronic kidney disease (CKD) and hypertension frequently coexist and confer high cardiovascular risk. Many patients require multidrug therapy, yet real-world antihypertensive use and blood pressure (BP) control in patients with CKD are poorly characterized. National registries can clarify treatment combinations, time to intensification, and the burden of uncontrolled BP in this high-risk population.
Purpose
To describe baseline characteristics and antihypertensive combinations in patients with hypertension and kidney disease, and to estimate the burden of uncontrolled BP among those receiving ≥4 antihypertensive classes.
Methods
Adults with hypertension and kidney disease (eGFR <60 ml/min/1.73 m2, urinary albumin–creatinine ratio ≥3 mg/mmol, or kidney disease diagnosis) were identified from Finnish registries (2014–2023). Patients with advanced CKD (two eGFR values <30 ml/min/1.73 m2 at baseline or index) were excluded. Follow-up ended at death, study end (31 Dec 2023), or emigration. Baseline characteristics at study entry were described for the full cohort. The index date for the ≥4-class cohort was the first dispensation of a fourth (or later) class including a diuretic. We summarized characteristics and treatment combinations at index, availability of structured BP data during follow-up, and the proportion with uncontrolled BP (≥140/90 mmHg) among those with BP data.
Results
The study population included 172,398 patients (mean age 72 years; 55% male) with median follow-up of 4.13 years; 88% had a hypertension and 47% a kidney disease diagnosis at baseline. Comorbidities included type 2 diabetes (T2D; 45%), atrial fibrillation (22%), and heart failure (HF; 17%). Overall, 51,914 patients (30%) initiated a fourth or later antihypertensive drug class including a diuretic during follow-up, at a median of 0.68 years after study entry. In this ≥4-class cohort, mean age was 74 years, 56% were male, and median follow-up was 3.59 years. At index, 94% had a hypertension diagnosis and 55% had a recorded kidney disease diagnosis. Comorbidities included T2D (57%), atrial fibrillation (34%), and HF (32%). The most common antihypertensive drug classes used at index are shown in Figure 1. The most common combination was diuretic + beta-blocker + calcium channel blocker + ACEi/ARB (60%). In the ≥4-class cohort, BP data were available for 36.3% of patients; among them, 70.5% had uncontrolled BP (13,291 patients; 25.6% of the ≥4-class cohort).
Conclusions
Nearly one third of Finnish patients with hypertension and kidney disease use ≥4 antihypertensive classes, suggesting frequent treatment intensification. Among those with BP data available, 7 in 10 remained uncontrolled despite ≥4 drug classes. These findings highlight opportunities to improve structured BP capture and optimize antihypertensive regimens in this high-risk population.