1.1. Terms and classifications used in the recommendation
Recommended level
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Sessions
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Level 1 "Recommendation"
Most patients should be treated as recommended
Level 2 "Offer"
Individualization may be required for each patient
Level of evidence
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Quality of evidence
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Meaningful
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A
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Tall
The actual effect is close to the estimate
REMOVE
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Medium
Actual effect may be close to estimate but still potentially different
OLD
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Short
Actual effects may differ significantly from estimates
EASY
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Very low
Estimates of the effect are highly uncertain, and often differ greatly from the actual effect.
Classification of albuminuria in CKD
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AER (mg/24 hours)
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ACR
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Sessions
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(mg/mmol)
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(mg/g)
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A1
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<30
<3
<30
Normal – slight increase
A2
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30-300
3-30
30-300
Average increase
A3
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> 300
> 30
> 300
Weight gain
ACR: albumin/creatinine ratio; AER: albuminuria elimination rate
1.2. Important recommendations
Note: RASi: inhibits the renin-angiotensin system, ACEi: ACE inhibitor, ARB: angiotensin II receptor blocker, DRI: direct renin inhibitor.
KDIGO has updated its standardized clinical blood pressure measurement according to the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH Guidelines for the Prevention, Detection, Evaluation, and Management of Hypertension in Adults. /ASPC/NMA/PCNA.
Important notes are illustrated in Figure 1. Notes for obtaining an accurate BP reading or detailed in the Standardized Clinical Blood Pressure Checklist.
Figure 1. Notes to get the correct BP readings
Image source:
Checklist for standardized clinical blood pressure measurement
first. Prepare the right patient
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1. Let the patient sit relax in a chair (2 feet on the floor, backrest) for at least 5 minutes
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2. Patients should avoid coffee, exercise, smoking at least 30 minutes before measuring BP
3. Make sure the patient's bladder is empty (urinated before BP measurement)
4. Neither the patient nor the observer speak during rest and during measurement
5. Take off clothes and jewelry at the measuring position
6. Measurements taken while the patient was sitting/lying on the hospital bed did not meet these criteria
2. Use the correct HA . meter
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1. Use a BP measuring device that has been calibrated and checked periodically.
2. Support the measuring arm for the patient (eg, put it on the table)
3. Place the bandage on the upper arm of the patient, the center point of the bandage is placed across the right atrium (mid sternum)
4. Use the correct size of the HA cuff so that the length of the cuff (inside the cuff) is at least equal to 80% circumference arm, if a larger or smaller cuff size is used, make a note
5. A large diaphragm or a stethoscope bell can be used to listen to the pulse
3.Implement the correct measurement technique needed for the diagnosis and treatment of hypertension
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1. At the first visit, record the BP of both arms. Measuring BP in the hand has higher results in the next time
2. Measurements are repeated 1-2 minutes apart
3. If measuring BP by listening to the pulse, before measuring BP, it is necessary to locate the brachial artery to place a stethoscope. After no longer seeing the pulse, need to inflate more 20-30mmHg
4. If you hear a pulse, release the air at a rate of 2mmHg/per second and pay attention to the Korotkoff sound to determine the systolic and diastolic BP.
4. Accurate reading of HA . results
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1. Record the systolic BP and diastolic BP. Systolic BP is the reading obtained at the time of the first appearance of the Korotkoff sound. Diastolic BP corresponds to the time of complete loss of Korotkoff voice. Round to nearest even number.
2. Pay attention and note down the most recent time of taking antihypertensive drugs (if any) before measuring.
5. Average readings
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Calculate the mean BP of at least 2 measurements to estimate BP.
6. Notify the measured BP to the patient
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Give the patient (say and write) their systolic/diastolic BP readings
References
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1. Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group. KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease. Kidney Int. 2021;99(3S):S1-S87. doi:10.1016/j.kint.2020.11.003
2. Cheung AK, Chang TI, Cushman WC, et al. Executive summary of the KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease. Kidney Int. 2021;99(3):559-569. doi:10.1016/j.kint.2020.10.026
3. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2018;138(17):e426-e483. doi:10.1161/CIR.0000000000000597
Compilation
DS. Tran Thi Thu Thuy – Faculty of Pharmacy, Saint Paul General Hospital
Proofreading
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DS Securities II. Nguyen Thi Dua – Head of Pharmacy Department of Saint Paul General Hospital
Mr. Vu Bich Hanh – Deputy Head of Pharmacy Department of Saint Paul General Hospital
Assoc.Prof.Dr. Nguyen Thanh Hai – Department of Clinical Pharmacy, Hanoi University of Pharmacy
Dr. Nguyen Tu Son - Department of Clinical Pharmacy, Hanoi University of Pharmacy
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