Blood Pressure Control Among Persons Without and With Chronic Kidney Disease: US Trends and Risk Factors 1999–2006

• Published in: Hypertension (Dallas, Tex. 1979) Vol. 54; no. 1; pp. 47 - 56
• Main Authors: Plantinga, Laura C., Miller, Edgar R., Stevens, Lesley A., Saran, Rajiv, Messer, Kassandra, Flowers, Nicole, Geiss, Linda, Powe, Neil R.
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD American Heart Association, Inc 01.07.2009; Lippincott Williams & Wilkins
• Subjects: Adult; Aged; Antihypertensive Agents - classification; Antihypertensive Agents - therapeutic use; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Blood Pressure - drug effects; Blood Pressure - physiology; Body Mass Index; Cardiology. Vascular system; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Diastole; Educational Status; Female; Health Surveys; Humans; Hypertension - complications; Hypertension - epidemiology; Hypertension - physiopathology; Income; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - physiopathology; Male; Medical sciences; Middle Aged; Prevalence; Risk Factors; Social Class; Systole; United States - epidemiology; Young Adult; United States; Hypertension; Kidney disease; chronic kidney disease; risk factors; Urinary system disease; Prevalence; Cardiovascular disease; treatment guidelines; blood pressure control; Treatment; Risk factor; Arterial pressure; Blood pressure; trends
• ISSN: 0194-911X; 1524-4563; 1524-4563
• DOI: 10.1161/HYPERTENSIONAHA.109.129841

Recent guidelines recommending more aggressive blood pressure control in patients with chronic kidney disease have unknown impact. We assessed trends in and predictors of blood pressure control in 8829 adult National Health and Nutrition Examination Survey 1999–2006 participants with hypertension (self-report, measured blood pressure, or use of antihypertensive medications), without (n=7178) and with (n=1651) chronic kidney disease. Uncontrolled blood pressure was defined as followsgeneral definition, systolic blood pressure ≥140 mm Hg and diastolic blood pressure ≥90 mm Hg, and disease-specific definition, systolic blood pressure ≥130 mm Hg and diastolic blood pressure ≥85 mm Hg (1999–2002) and systolic blood pressure ≥130 mm Hg and diastolic blood pressure ≥80 mm Hg (2003–2006) for those with chronic kidney disease (estimated glomerular filtration rate<60 mL/min per 1.73 m) or diabetes mellitus (self-report). Proportions with uncontrolled blood pressure in 1999–2006 were greater in those with chronic kidney disease versus those without chronic kidney disease (51.5% versus 48.7% [general definitionP=0.122] and 68.8% versus 51.7% [disease-specific definitionP<0.001]). In those with chronic kidney disease, there were significant decreases in uncontrolled blood pressure over time (55.9% to 47.8% [general definitionP=0.011]). With adjustment for demographic, socioeconomic, and clinical variables, older age (P<0.001) and lack of antihypertensive treatment (P<0.001) were associated with uncontrolled blood pressure, regardless of chronic kidney disease status; nonwhite race (P=0.002) was associated in those without chronic kidney disease, whereas female sex (P=0.030) was associated in those with chronic kidney disease. Multiple medications (P<0.001) and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (P=0.001) were associated with less uncontrolled blood pressure. Although some improvement has occurred over time, uncontrolled blood pressure remains highly prevalent, especially in subjects with chronic kidney disease and in nonwhites, older persons, and women. Therapy appears suboptimal.