Hypertension awareness, treatment, and control in adults with CKD: results from the Chronic Renal Insufficiency Cohort (CRIC) Study

Abstract

Background: A low rate of blood pressure control has been reported in patients with chronic kidney disease (CKD). These data were derived from population-based samples with a low rate of CKD awareness.

Study design: Cross-sectional.

Setting & participants: Data from the baseline visit of the Chronic Renal Insufficiency Cohort (CRIC) Study (n = 3,612) were analyzed. Participants with an estimated glomerular filtration rate of 20-70 mL/min/1.73 m(2) were identified from physician offices and review of laboratory databases.

Outcomes: Prevalence and awareness of hypertension, treatment patterns, control rates, and factors associated with hypertension control.

Measurements: Following a standardized protocol, blood pressure was measured 3 times by trained staff, and hypertension was defined as systolic blood pressure > or =140 mm Hg and/or diastolic blood pressure > or =90 mm Hg and/or self-reported antihypertensive medication use. Patients' awareness and treatment of hypertension were defined using self-report, and 2 levels of hypertension control were evaluated: systolic/diastolic blood pressure <140/90 and <130/80 mm Hg.

Results: The prevalence of hypertension was 85.7%, and 98.9% of CRIC participants were aware of this diagnosis and 98.3% were treated with medications, whereas 67.1% and 46.1% had hypertension controlled to <140/90 and <130/80 mm Hg, respectively. Of CRIC participants with hypertension, 15%, 25%, 26%, and 32% were using 1, 2, 3, and > or =4 antihypertensive medications, respectively. After multivariable adjustment, older patients, blacks, and those with higher urinary albumin excretion were less likely, whereas participants using angiotensin-converting enzyme inhibitors and angiotensin receptor blockers were more likely to have controlled their hypertension to <140/90 and <130/80 mm Hg.

Limitations: Data were derived from a single study visit.

Conclusions: Despite almost universal hypertension awareness and treatment in this cohort of patients with CKD, rates of hypertension control were suboptimal.

Figure 1

Systolic and diastolic blood pressure distribution among participants in the Chronic Renal Insufficiency Cohort (CRIC) study (n=3612). Abbreviations: SBP – systolic blood pressure; DBP – diastolic blood pressure.

Figure 2

Overall rates of hypertension prevalence, awareness, treatment and control among participants of the Chronic Renal Insufficiency Cohort (CRIC) study. HTN-hypertension (prevalence among all CRIC participants; Aware and Treated are the percent among all participants with hypertension. Hypertension control rates are calculated for all CRIC participants with hypertension.

Figure 3

Number of blood pressure medications being taken by participants and blood pressure control in the Chronic Renal Insufficiency Cohort study.