Hypertension control and antihypertensive therapy in patients with chronic kidney disease

Abstract

Background: Hypertension is a major risk factor in the progression of chronic kidney disease (CKD). Although hypertension is more prevalent and treated more often among CKD patients, it is less likely to be controlled. Current guidelines recommend the use of multiple antihypertensive agents to achieve optimal blood pressure (BP) control. However, BP control attained by number and type of antihypertensive therapy according to CKD stage has not been examined thoroughly.

Study design: Cross-sectional analysis of an electronic medical record (EMR) database.

Setting and participants: A total of 115,608 patients with CKD (Stages 1-4) and diagnosed or treated hypertension in General Electric Centricity EMR from 1996 to 2012.

Outcome: BP control, based on JNC 7 guidelines, was defined as less than 130/80 mm Hg.

Measurements: BP and antihypertensive therapy use was obtained from the EMR. The Cockcroft-Gault equation was used to calculate estimated glomerular filtration rate and classify CKD stage.

Results: Overall prevalence of BP control was 24.3%. BP control varied by CKD stage and number of antihypertensive therapy. In multivariable analysis, younger age was less likely to be associated with BP control, regardless of CKD stage. Multiple antihypertensive therapy use and BP control was strongest among CKD Stage 2 (odds ratio (OR): 1.41; 95% confidence interval (CI): 1.05, 1.90). Diuretic use was less likely to be associated with BP control among CKD Stage 1 (OR: 0.71; 95% CI: 0.59, 0.87) and 2 (OR: 0.78; 95% CI: 0.72, 0.85).

Limitations: Information on antihypertensive prescription fill data and adherence to medication regimens was unavailable.

Conclusions: This study highlighted the need to pay closer attention to achieving BP treatment goals for younger individuals with CKD. More research is needed to assess the extent to which specific combinations of antihypertensive drugs leads to adequate BP control.

Keywords: antihypertensive therapy; blood pressure control; chronic kidney disease; electronic medical record; hypertension..