Tada Kazuhiro, Nakano Yuki, Takahashi Koji, Hiyamuta Hiroto, Watanabe Maho, Ito Kenji, Yasuno Tetsuhiko, Abe Makiko, Satoh Atsushi, Kawazoe Miki, Maeda Toshiki, Yoshimura Chikara, Kosuke Masutani, Arima Hisatomi
Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
Department of Pharmacy, Saiseikai Futsukaichi Hospital, Fukuoka, Japan.
Hypertens Res. 2025 Jan;48(1):244-255. doi: 10.1038/s41440-024-01896-0. Epub 2024 Sep 19.
Japanese guidelines recommend angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) as first-line therapy in hypertensive patients with chronic kidney disease (CKD) and proteinuria, but calcium channel blockers in patients with stage G4-5 CKD aged ≥75 years; however, the implementation of these guidelines in clinical practice is unclear. We investigated the actual use of these agents in this patient population. We conducted a cross-sectional study using the DeSC database, which includes anonymous information from various health insurance systems in Japan. A total of 34,362 hypertensive patients aged <75 years with CKD stage G1-G5 with urinary protein ≥1+ or aged ≥75 years with CKD stage G1-G3 with urinary protein ≥1+, for whom Japanese guidelines recommend first-line ARBs/ACEIs, were included in the analysis. Prescription rates of ARBs and ACEIs were calculated overall and separately for each age group and glomerular filtration rate category. The mean participant age was 65.8 ± 14.8 years, including 24,585 patients (72%) <75 years and 9777 (28%) ≥75 years. Of these, 9529 were prescribed ARBs/ACEIs (prescription rate 28%). The prescription rate was lower in patients aged <75 years with CKD stage G1-G5 (prescription rate 23%) compared with patients aged ≥75 years old with CKD stage G1-G3 (prescription rate 41%) (p < 0.001). Patients with CKD stage G1 had the lowest prescription rates for ARBs/ACEIs in both age categories. These results indicate that, despite guideline recommendations, ARBs/ACEIs are insufficiently prescribed for patients with hypertension associated with CKD with proteinuria. ARBs and ACEIs were only used in 28% of hypertensive patients aged<75 years (CKD stage G1-G5) or aged ⩾75 years (CKD stage G1-G3), with urinary protein ⩾1+, for whom Japanese guidelines recommend ARBs/ACEIs. The prescription rate was lower in the younger compared with the older patients.
日本指南推荐血管紧张素 II 受体阻滞剂（ARBs）和血管紧张素转换酶抑制剂（ACEIs）作为慢性肾脏病（CKD）合并蛋白尿的高血压患者的一线治疗药物，但对于年龄≥75 岁的 G4 - 5 期 CKD 患者推荐使用钙通道阻滞剂；然而，这些指南在临床实践中的实施情况尚不清楚。我们调查了这些药物在该患者群体中的实际使用情况。我们使用 DeSC 数据库进行了一项横断面研究，该数据库包含来自日本各种医疗保险系统的匿名信息。分析纳入了总共 34362 例高血压患者，其中年龄<75 岁且 CKD 分期为 G1 - G5 且尿蛋白≥1+，或年龄≥75 岁且 CKD 分期为 G1 - G3 且尿蛋白≥1+，日本指南推荐一线使用 ARBs/ACEIs。总体以及按每个年龄组和肾小球滤过率类别分别计算 ARBs 和 ACEIs 的处方率。参与者平均年龄为 65.8±14.8 岁，其中 24585 例患者（72%）年龄<75 岁，9777 例（28%）年龄≥75 岁。其中，9529 例患者开具了 ARBs/ACEIs（处方率 28%）。与年龄≥75 岁且 CKD 分期为 G1 - G3 的患者（处方率 41%）相比，年龄<75 岁且 CKD 分期为 G1 - G5 的患者处方率较低（处方率 23%）（p<0.001）。在两个年龄类别中，CKD 分期为 G1 的患者 ARBs/ACEIs 的处方率最低。这些结果表明，尽管有指南推荐，但对于合并蛋白尿的 CKD 相关高血压患者，ARBs/ACEIs 的处方不足。ARBs 和 ACEIs 仅在 28%的年龄<75 岁（CKD 分期 G1 - G5）或年龄≥75 岁（CKD 分期 G1 - G3）且尿蛋白≥1+的高血压患者中使用，日本指南推荐这些患者使用 ARBs/ACEIs。年轻患者的处方率低于老年患者。
