OBJECTIVE: Real-life management of hypertensive patients with chronic kidney disease (CKD) is unclear. METHODS: A survey was conducted in 2023 by the European Society of Hypertension (ESH) to assess management of CKD patients referred to ESH-Hypertension Excellence Centres (ESH-ECs) at first referral visit. The questionnaire contained 64 questions with which ESH-ECs representatives were asked to estimate preexisting CKD management quality. RESULTS: Overall, 88 ESH-ECs from 27 countries participated (fully completed surveys: 66/88 [75.0%]). ESH-ECs reported that 28% (median, interquartile range: 15-50%) had preexisting CKD, with 10% of them (5-30%) previously referred to a nephrologist, while 30% (15-40%) had resistant hypertension. The reported rate of previous recent (<6 months) estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR) testing were 80% (50-95%) and 30% (15-50%), respectively. The reported use of renin-angiotensin system blockers was 80% (70-90%). When a nephrologist was part of the ESH-EC teams the reported rates SGLT2 inhibitors (27.5% [20-40%] vs. 15% [10-25], P = 0.003), GLP1-RA (10% [10-20%] vs. 5% [5-10%], P = 0.003) and mineralocorticoid receptor antagonists (20% [10-30%] vs. 15% [10-20%], P = 0.05) use were greater as compared to ESH-ECs without nephrologist participation. The rate of reported resistant hypertension, recent eGFR and UACR results and management of CKD patients prior to referral varied widely across countries. CONCLUSIONS: Our estimation indicates deficits regarding CKD screening, use of nephroprotective drugs and referral to nephrologists before referral to ESH-ECs but results varied widely across countries. This information can be used to build specific programs to improve care in hypertensives with CKD.

1st Department of Cardiology National and Kapodistrian University of Athens Hippocratio Hospital Greece

1st Department of Internal Medicine Cardiology Faculty of Medicine and Dentistry Palacky University Olomouc and University Hospital Olomouc Czech Republic

2nd Deparment od Internal Medicine of St Anne's University Hospital Brno and Fakulty of Medicine Masaryk University Brno Czechia

2nd Department of Cardiology Medical School University of Athens ATTIKON Hospital Athens

2nd Prop Department of Internal Medicine Aristotle University Thessaloniki Greece

3rd Department of Internal Medicine Papageorgiou Hospital Aristotle University of Thessaloniki Greece

AP HP Unité d'hypertension artérielle service de médecine interne Hôpital Avicenne Bobigny France

Cardiovascular Risk and Hypertension Hospital Madrid Spain

Cardiovascular Risk Clinic Western General Hospital Edinburgh UK

Center of Preventive Cardiology Hospital N2 CJSC Yerevan Armenia

Centre for Hypertension 3rd Internal Department General Faculty Hospital Charles University Prague Czech Republic

Centre of Cardiology North Estonia Medical Centre Tallinn University of Technology Tallinn Estonia

Charité Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin Institute of Clinical Pharmacology and Toxicology Berlin Germany

Charité Universitätsmedizin Berlin Medinische Klinik für Nephrologie und internistische Intensivtherapie Berlin Germany

Clinica di Medicina Interna 2 Università degli Studi e IRCCS Ospedale Policlinico San Martino di Genova

Clinica Medica University Milano Bicocca Milan Italy

Department of Advanced Medical Sciences Federico 2 University of Naples Naples Italy

Department of Cardiology Abdali Hospital Amman Jordan

Department of Cardiology Istituto Auxologico Italiano IRCCS Milan Italy; Department of Medicine and Surgery University of Milano Bicocca Milan Italy

Department of Cardiology LAIKO General Hospital Athens Greece

Department of Cardiology Medical University of Graz Graz Austria

Department of Cardiovascular Diseases Internal Medicine University Hospital Ghent Ghent Belgium

Department of Clinical and Experimental Sciences University of Brescia and ASST Spedali Civili Italy

Department of Clinical Sciences Lund University Skane University Hospital Malmö Sweden

Department of Heart Disease Haukeland University Hospital Bergen Norway

Department of Internal Medicine 4 ; Medical University Innsbruck Austria

Department of Internal Medicine and Cardiology University Hospital Ostrava and Faculty of Medicine University of Ostrava Czech Republic

Department of Internal Medicine Montpellier University Hospital Montpellier France and PhyMedExp INSERM U1046 CNRS UMR 9214 University of Montpellier Montpellier France

Department of Internal Medicine Nephrology Heinrich Heine University Duesseldorf Duesseldorf Germany

Department of Internal Medicine Section of Nephrology Amsterdam University Medical Center Amsterdam Cardiovascular Sciences University of Amsterdam Amsterdam The Netherlands

Department of Medical Sciences University of Turin Turin Italy

Department of Medicine and Surgery University of Perugia Unit of Internal Medicine Santa Maria Terni Hospital Terni Italy

Department of Medicine Radboud University Medical Center Nijmegen The Netherlands

Department of Nephrology and Hypertension University Hospital Erlangen Friedrich Alexander University Erlangen Nürnberg Erlangen Germany

Department of Nephrology Cantonal Hospital Graubuenden Chur Switzerland

Department of Nephrology Helsinki University Hospital and University of Helsinki Biomedicum 2 Helsinki Helsinki Finland

Division of Cardiology Department of Cardiovascular Diseases Cliniques Universitaires Saint Luc and Pole of Cardiovascular Research Institut de Recherche Expérimentale et Clinique Université Catholique de Louvain Brussels Belgium

Division of Medicine Turku University Hospital Turku University Turku Finland

Division of Nephrology University of Liège Hospital Cardiovascular Sciences University of Liège Liège Belgium

Emergency Clinical Hospital of Bucharest Bucharest Romania

ESH Excellent Center Hypertension LAIKO University Hospital Athens Greece

Faculty of Medicine Oporto Portugal

Grande Ospedale Metropolitano UOC di Nefrologia abilitata al trapianto renale CNR Epidemiologia Clinica e Fisiopatologia delle Malattie Renali e dell'Ipertensione Arteriosa Reggio Calabria Italy

Hôpital Ed Herriot Department of Nephrology and Hypertension Lyon

Hospital Centre of Vila Nova de Gaia Espinho Internal Medicine Department Hypertension and Cardiometabolic Risk Unit ESH Excellence Centre Vila Nova de Gaia Portugal

Hospital Universitario de Badajoz Badajoz Spain

Hypertension and Vascular Risk Unit Department of Nephrology Hospital del Mar IMIM Universitat Pompeu Fabra Barcelona Catalonia Spain

Hypertension Center Department of Nephrology and Hypertension Hannover Medical School Hannover Germany

Hypertension Center STRIDE 7 National and Kapodistrian University of Athens School of Medicine 3rd Department of Medicine Sotiria Hospital Athens Greece

Hypertension Clinic Hadassah Hebrew University Medical Center Mount Scopus Jerusalem and Faculty of Medicine Hadassah Hebrew University School of Medicine Jerusalem Israel

Hypertension Outpatient Clinic Cardiology Department Heraklion University General Hospital Heraklion Crete Greece

Hypertension Unit Department of Cardiology HELORA University Hospitals Mons Belgium

Hypertension Unit Department of Internal Medicine Hospital Clinic University of Barcelona Spain

Hypertension Unit Department of Internal Medicine University Hospital of Heraklion Heraklion

Hypertension Unit KAT General Hospital of Attica Attica Greece

Hypertension Unit of the 1st Department of Medicine Aristotle University of Thessaloniki AHEPA Hospital Thessaloniki

Hypertoniezentrum Bonn Schwerpunktpraxis Kardiologie Angiologie Prävention Rehabilitation Bonn Germany

Izmir Medicana International Hospital Division of Cardiology Konak Izmir Turkey

Karolinska Institutet Department of Clinical Sciences Division of Cardiovascular Medicine Stockholm Sweden; and Danderyd University Hospital Corp Department of Cardiology Stockholm Sweden

Klinikum Wels Grieskirchen

Medical Outpatient Department and Hypertension Clinic University Hospital Basel Basel Switzerland

Medical University of Warsaw Warsaw Poland

Metropolitan Hospital Piraeus

Peart Rose Clinic Hammersmith Hospital Imperial College Healthcare Trust London UK

Plava Medical Group Sarajevo Bosnia and Herzegovina

PROMISE Department Nephrology and Dialysis Unit with Hypertension ESH Excellence Centre University Hospital P Giaccone; University of Palermo Palermo Italy

School of Medicine Aristotle University of Thessaloniki Thessaloniki Greece

Service d'HTA et Therapeutique CHU Rangueil Toulouse University Toulouse

Service de cardiologie Hôpital de la Timone Marseille France

Service de Médecine Interne Hôpital Franco Britannique Levallois Perret France

Service de Néphrologie CIC CRB 1404 INSERM EnVi U1096 CHU Rouen Rouen France

Service de néphrologie et d'hypertension Lausanne University Hospital and University of Lausanne Lausanne Switzerland

Service de Néphrologie Hypertension Dialyses Transplantation rénale Hôpital Bretonneau CHU Tours Tours France

Service de Néphrologie transplantation dialyse aphérèses CHU Bordeaux France

South Buda Center Hospital St Imre University Teaching Hospital Budapest Hungary

St George University Medical Center Achrafieh Beirut Lebanon

St Josefs Hospital Cloppenburg Germany

UF Hypertension et Athérothrombose Centre Européen d'Excellence en Hypertension Artérielle Service de Cardiologie Pôle Thorax et Vaisseaux CHU Michallon Grenoble France

Università Politecnica delle Marche and IRCCS INRCA Ancona Italy

Universitair Ziekenhuis Brussel VUB Belgium

Université Paris Cité Paris France; APHP Service d'Hypertension Artérielle Hôpital Européen Georges Pompidou Paris France

University Hospital of North Norway Tromsø Norway

University Hospital Zurich University Heart Center Cardiology and University of Zurich Zurich Switzerland

UOC Medicina Interna Centro Ipertensione di Eccellenza Europea ESH Azienda ULSS 5 Polesana Ospedale di Adria Italy

Vascular Risk Unit Internal Medicine Virgen de las Nieves University Hospital Granada Spain

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