Hypertension Awareness, Treatment, and Control in Adults With CKD: Results From the Chronic Renal Insufficiency Cohort (CRIC) Study
Received 14 May 2009; accepted 4 September 2009. published online 07 December 2009.
Refers to article:
Blood Pressure Control in CKD Patients: Why Do We Fail to Implement the Guidelines?
Gavin J. Becker, David C. Wheeler
American Journal of Kidney Diseases
March 2010 (Vol. 55, Issue 3, Pages 415-418) Full Text |
Full-Text PDF (145 KB)
Background
A low rate of blood pressure control has been reported in patients with chronic kidney disease (CKD). These data were derived from population-based samples with a low rate of CKD awareness.
Study Design
Cross-sectional.
Setting & Participants
Data from the baseline visit of the Chronic Renal Insufficiency Cohort (CRIC) Study (n = 3,612) were analyzed. Participants with an estimated glomerular filtration rate of 20-70 mL/min/1.73 m2 were identified from physician offices and review of laboratory databases.
Outcomes
Prevalence and awareness of hypertension, treatment patterns, control rates, and factors associated with hypertension control.
Measurements
Following a standardized protocol, blood pressure was measured 3 times by trained staff, and hypertension was defined as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg and/or self-reported antihypertensive medication use. Patients' awareness and treatment of hypertension were defined using self-report, and 2 levels of hypertension control were evaluated: systolic/diastolic blood pressure <140/90 and <130/80 mm Hg.
Results
The prevalence of hypertension was 85.7%, and 98.9% of CRIC participants were aware of this diagnosis and 98.3% were treated with medications, whereas 67.1% and 46.1% had hypertension controlled to <140/90 and <130/80 mm Hg, respectively. Of CRIC participants with hypertension, 15%, 25%, 26%, and 32% were using 1, 2, 3, and ≥4 antihypertensive medications, respectively. After multivariable adjustment, older patients, blacks, and those with higher urinary albumin excretion were less likely, whereas participants using angiotensin-converting enzyme inhibitors and angiotensin receptor blockers were more likely to have controlled their hypertension to <140/90 and <130/80 mm Hg.
Limitations
Data were derived from a single study visit.
Conclusions
Despite almost universal hypertension awareness and treatment in this cohort of patients with CKD, rates of hypertension control were suboptimal.
8Case Western Reserve University, University Hospitals Case Medical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH
9Division of Nephrology, University of Maryland School of Medicine, Baltimore, MD
Address correspondence to Paul Muntner, Department of Epidemiology, University of Alabama at Birmingham, 1665 University Blvd, Ste 230J, Birmingham, AL 35294
ABSTRACT