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. 2021 Jan;77(1):94-102.
doi: 10.1161/HYPERTENSIONAHA.120.16281. Epub 2020 Nov 16.

Angiotensin-Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Use Among Hypertensive US Adults With Albuminuria

Chi D Chu  1 , Neil R Powe  1   2 , Charles E McCulloch  3 , Tanushree Banerjee  1 , Deidra C Crews  4 , Rajiv Saran  5 , Jennifer Bragg-Gresham  6 , Hal Morgenstern  7 , Meda E Pavkov  8 , Sharon H Saydah  8 , Delphine S Tuot  1   2 ; Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team
Affiliations

Angiotensin-Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Use Among Hypertensive US Adults With Albuminuria

Chi D Chu et al. Hypertension. 2021 Jan.

Abstract

Since 2003, US hypertension guidelines have recommended ACE (angiotensin-converting enzyme) inhibitors or ARBs (angiotensin receptor blockers) as first-line antihypertensive therapy in the presence of albuminuria (urine albumin/creatinine ratio ≥300 mg/g). To examine national trends in guideline-concordant ACE inhibitor/ARB utilization, we studied adults participating in the National Health and Nutrition Examination Surveys 2001 to 2018 with hypertension (defined by self-report of high blood pressure, systolic blood pressure ≥140 mm Hg or diastolic ≥90 mm Hg, or use of antihypertensive medications). Among 20 538 included adults, the prevalence of albuminuria ≥300 mg/g was 2.8% in 2001 to 2006, 2.8% in 2007 to 2012, and 3.2% in 2013 to 2018. Among those with albuminuria ≥300 mg/g, no consistent trends were observed for the proportion receiving ACE inhibitor/ARB treatment from 2001 to 2018 among persons with diabetes, without diabetes, or overall. In 2013 to 2018, ACE inhibitor/ARB usage in the setting of albuminuria ≥300 mg/g was 55.3% (95% CI, 46.8%-63.6%) among adults with diabetes and 33.4% (95% CI, 23.1%-45.5%) among those without diabetes. Based on US population counts, these estimates represent 1.6 million adults with albuminuria ≥300 mg/g currently not receiving ACE inhibitor/ARB therapy, nearly half of whom do not have diabetes. ACE inhibitor/ARB underutilization represents a significant gap in preventive care delivery for adults with hypertension and albuminuria that has not substantially changed over time.

Keywords: albuminuria; angiotensin receptor antagonists; angiotensin-converting enzyme inhibitors; blood pressure; guideline adherence.

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Conflict of interest statement

Disclosures: Dr. Crews serves on an advisory board of Bayer HealthCare Pharmaceuticals, Inc. The remaining authors have nothing to disclose.

Figures

Figure 1.
Figure 1.. Age-adjusted ACEi/ARB usage among hypertensive US adults with UACR ≥300 mg/g, overall and by diabetes status, NHANES 2001-2018 (n = 849).
Abbreviations: ACEi = angiotensin converting enzyme inhibitor; ARB = angiotensin receptor blocker; NHANES = National Health and Nutrition Examination Survey; UACR = urine albumin/creatinine ratio.
See this image and copyright information in PMC

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