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Arterial hypertension(AH) is one of the leading causes of chronic kidney disease (CKD) and major adverse cardiac outcomes worldwide. Moreover, blood pressure levels must be adequate according to the patient´s risk factors and target organ damage. In 2021,the Kidney Disease Improving Global Outcomes released an update in the blood pressure (BP) management guidelines in CKD patients, focusing on BP targets according to the estimated glomerular filtration strata and the correct BP operation method.Middle-income and low-income countries have disparities between specialist distributions.Brazil, the largest country in South America, reported in the 2022 national census 5.494 board-certified nephrologists to 214.820.000 inhabitants. Lyanage et al. reported that the most significant treatment gaps occurred in Asia, with 17%-34% of people needing kidney replacement therapy (KRT) treated, and in Africa, with only 9%-16% of patients needing KRT treated. This gap might guide patients to nonconventional forms of getting information about their kidney health treatment.To this point,we aim to evaluate the performance of the most important artificial intelligence(AI) tools to guide AH treatment, one of the most important causes of CKD.
We conducted a systematic search with the leading AI tools used worldwide,Chat-GPT 4 from OpenAi and Bard from Google,to evaluate their recommendations for AH treatment.We chose the most used medications in Brazil to treat AH and prompted both computer engines with the same question: " Is X safe to treat systemic arterial hypertension?".The answers given were categorized into the following strata:"Yes,it is safe","No,it is not safe" without any explanation, "No,it is not safe" with some explanation.After the answers categorization,we checked the Lexicomp Free Drug Interactions software as the standard to either confirm or deny the confirmation of safety recommendations for the drugs asked.The same binary outcomes were used.In order to avoid personal bias, two researchers conducted the search independently and a third one checked the answers when they were not the same.
We performed a thorough search for the most used and prescribed drugs that may control AH in Brazil.A total of 72 drugs were found,as it is shown in Table 1.The capital classes of drugs were diuretics, angiotensin conversion enzyme inhibitors, angiotensin receptor blockade, calcium channel blockers, beta-blockers, nitrates, renin inhibitors,alpha-2 adrenergic agonists,direct vasoactive agents.Chat-GPT 4 correctly identified the safety of the drug recommendation in 56,9% of the cases.On the other hand,Bard correctly identified the drug recommendation's safety in 50% of the consultations.Chat-GPT 4 and Bard agreed between them in 93,3% of the consultations.Among the drug categories analyzed,beta-blockers and vasoactive agents had the higher disparities indication between the AI tools and Lexicomp Free Drug Interaction software.
In this review, the most used AI tools performed with a low accuracy rate to answer whether AH drugs are safe compared to the gold-free standard software. Despite the update of CKD BP guidelines, improving the knowledge of CKD prevention and the population's access to board-certified nephrologists is essential.