Abstract 14112: Treatment Patterns and Blood Pressure Management Among US Adults With CKD and Hypertension: NHANES 2007-2010
Methods: We assessed antihypertensive (α-HTN) use and blood pressure (BP) control among 4312 (self-reported or undiagnosed) hypertensive (HTN) US adults, including 1336 with comorbid chronic kidney disease (CKD). Among non-pregnant 2007-2010 NHANES participants with available BP, serum, and urinary measures, HTNs were identified based on self-reported interview and/or measured BP. Controlled BP was defined as SBP<140mmHg and DBP<90mmHg. All proportions are representative of the US population.
Results: Among HTN adults, 50.4% were female, 72.5% white, 12.6% black, 5.9% Mexican American and 25% had concomitant CKD. Relative to hypertensives without CKD, those with CKD tended to be older, more often female, and had more comorbidities. Among HTNs with CKD, those treated with antihypertensives tended to be older, more often female, had more comorbidities, and had better controlled BP levels compared to untreated patients. Among treated HTNs, more than 30% had suboptimal BP control, though over 75% were taking 2 or fewer α-HTNs. HTN subjects with CKD tended to be on more α-HTNs compared to those without, though fewer had controlled BP (58.8% vs. 74.1%, p<0.0001). Among HTNs with CKD, patients with lower eGFR tended to take more α-HTNs, yet a median of only 2, and 3 α-HTNs were used among all CKD patients with eGFR > and <30 mL/min/1.73m2, respectively.
Conclusion: Reaching controlled BP levels continues to be a problem among HTN US adults, even among those on multiple antihypertensives. Lack of BP control among hypertensives with concomitant CKD is even more common. Observations suggest that hypertensives, especially those with CKD, may not be sufficiently aggressively treated, may not be responsive to their current treatment(s) and/or they may not be compliant with reported treatments. These trends should be further examined along with patient adherence to medications to better inform evolving treatment guidelines, therapeutic developments, and improve BP management.
- © 2013 by American Heart Association, Inc.