Mind the Kidney: Assessing Antihypertensive Dose Adjustment  Based on Creatinine Clearance and Its Clinical Impact

Emy Oktaviani; Dian Farida Ismyama; Khansa Mahdyah

Authors

Emy Oktaviani Department of Pharmacy, Universitas Pakuan, Bogor, Indonesia
Dian Farida Ismyama Department of Pharmacy, Universitas Pakuan, Bogor, Indonesia
Khansa Mahdyah Department of Pharmacy, Universitas Pakuan, Bogor, Indonesia

Keywords:

Antihypertensive, Blood Pressure, Chronic Kidney Deseases, Dose Adjustment

Abstract

Hypertension is a disease characterized by continuously elevated blood pressure, which increases pressure in the kidneys and results in nephron damage.Decreased kidney function disturbs the pharmacokinetics of drugs in the body, resulting in toxic effects. In patients with hypertension and chronic kidney disease (CKD), it is necessary to adjust the dose of antihypertensive therapy using the GFR value.The aim of this study is to evaluate the dose regimen adjustment and its clinical outcome (blood pressure) and to analyze the correlation between the two.The study design is cross sectional with retrospective data through medical records of outpatient hypertensive with CKD from 2016-2020 in RSUP Fatmawati Jakarta. The results showed that of the 174 patients who met the inclusion criteria, 343 drugs were prescribed and 139 patients (79.9%) had an appropriate dose adjustment. Of those patients, 53.45% had controlled blood pressure and 26.44% had uncontrolled blood pressure. While 35 patients (20.1%) had an inappropriate dose adjustment, 12.64% of these patients were controlled and 7.47% were uncontrolled. Of the 343 prescribed drugs, bisoprolol has the highest rate of inappropriate dose adjustment. There was no significant correlation between dose adjustment suitability and blood pressure control (p-value = 0.651). However, comorbidities can affect both the suitability of dose adjustment (p-value = 0.024) and blood pressure (p-value = 0.037).

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