Trends in Blood Pressure Control in US Adult CKD Patients from 1999 to 2018

Abstract

Background: Blood pressure (BP) control can slow down the progression of chronic kidney disease (CKD) and protect against cardiovascular diseases, significantly improving patient survival. Herein, we analyzed the changes in BP control in adult CKD patients with hypertension in the United States from 1999-2000 to 2017-2018. Methods: National Health and Nutrition Examination Survey (NHANES) data from 1999-2000 to 2017-2018 were analyzed, including 5,510 adult CKD patients with BP above 140/90 mmHg or those under an antihypertensive regimen. Results: The proportion of adult CKD patients with uncontrolled BP decreased from 72.9% in 1999-2000 to 46.6% in 2013-2014, then increased to 56.9% in 2017-2018. Although adult CKD patients with albumin-creatinine rate (ACR) 30-299 mg/g or ACR ≥300 mg/g were more likely to take antihypertensive medication than those with ACR <30 mg/g (PR: 2.76, 95% CI: 1.63-4.79 and PR: 4.59, 95% CI: 2.37-9.51), they were more likely to have uncontrolled BP than those with ACR <30 mg/g ((multivariable-adjusted prevalence ratio (PR): 2.25, 95% CI: 1.39-3.75 and PR: 3.14, 95% CI: 1.71-6.07). Adult CKD patients (eGFR ≥60 mL/min/1.73m²) being aware of their high BP diagnosis were less likely to take antihypertensive medication than those with eGFR 30-59 mL/min/1.73m² (PR: 0.27, 95% CI: 0.09-0.65). Conclusions: These results show that BP control should be reinforced in adult CKD patients, particularly in those with ACR ≥300 mg/g, while patients with eGFR ≥60 mL/min/1.73m² should enhance awareness of taking antihypertensive medication.

Keywords: chronic kidney disease; clinical practice guidelines; high blood pressure; hypertension.

Figure 1

Percentage of adult CKD with high BP. The percentage of adult CKD participants with high BP decreased from 1999-2000 through 2003-2004, and increased from 2005-2006 through 2017-2018. Error bars indicate 95% confidence intervals. Hypertension was defined by systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg and/or antihypertensive medication use. Abbreviations: BP, blood pressure.

Figure 2

Percentage of CKD adults with uncontrolled BP according to different guidelines. Trends for uncontrolled BP among adult CKD participants with high BP were nonlinear, with an inflection point around 2013-2014. Error bars indicate 95% confidence intervals. Abbreviations: ACC: American College of Cardiology; AHA: American Heart Association; JNC8: the Eighth Joint National Committee; KDIGO: Kidney Disease Improving Global Outcomes.

Figure 3

Trends of CKD adults with hypertension taking antihypertensive medication. Trends for adult CKD participants taking antihypertensive medication were nonlinear, with an inflection point around 2011-2012. Error bars indicate 95% confidence intervals.