Abstract 14037: Treatment Characteristics and Blood Pressure Control in Hypertensive Patients With Chronic Kidney Disease: Evidence From Ambulatory Care Practice Data in the US
Background: Clinical studies have demonstrated that hypertension (HTN), a common comorbid condition among chronic kidney disease (CKD) patients, is a risk factor for CKD progression. The goal of this study was to examine treatment characteristics and level of blood pressure (BP) control among hypertensive patients with CKD in the US.
Methods: A national electronic medical record (EMR) research database was used to identify patients with CKD based on reported ICD-9 codes 585.x, 403.x, or 404.x from 2002-12. CKD stages were defined according to the National Kidney Foundation guidelines based on the estimated glomerular filtration rate (eGFR) calculated with the Cockroft-Gault equation. Patients were classified as hypertensive if they had either a diagnosis of HTN (ICD-9 codes: 401-405, 255.10), were treated with antihypertensive agents or had SBP>130 or DBP>80mmHg. Blood pressure (BP) outcome was assessed based on a minimum of 2 recorded BP measurements during the study period (60-420 days).
Results: Of the 159,306 CKD patients identified, 82.4% had HTN. Patients with HTN had a mean (SD) age of 70.1 (11.1) years, 48.2% were male, 44.8% had comorbid diabetes and 14.6% had peripheral edema. Mean (SD) eGFR was 58.0 (30.3) mL/min/1.73m2 and serum creatinine 1.5 (0.6) mg/dL. Antihypertensive drug therapy was observed in 84.8% of HTN patients. Among treated patients, 27.2% were prescribed a single agent, while 72.8% received combination therapy (35.6%, 32.8%, 19.9%, and 11.7% with 2-5+ classes of medications, respectively). Angiotensin-converting-enzyme inhibitors or angiotensin II receptor blockers comprised 43.0% of monotherapy and 77.0% of combination therapies. The number of medication classes, as well as the use of loop diuretics, increased with the stage of CKD. Treated patients had a mean (SD) SBP/DBP of 133.0 (19.9)/74.0 (11.7) mmHg, with only 36.9% achieving BP goal (SBP/DBP<130/80).
Conclusions: Hypertension is a common comorbidity among CKD patients that remains largely uncontrolled despite the availability of multiple classes of medications. Better understanding of contributing factors to poor BP control in hypertensive CKD patients is needed.
- © 2013 by American Heart Association, Inc.