Hypertension awareness, treatment, and control in adults with CKD: results from the Chronic Renal Insufficiency Cohort (CRIC) Study

Abstract

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 m(2) 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 > or =140 mm Hg and/or diastolic blood pressure > or =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 > or =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.

Copyright 2010 National Kidney Foundation, Inc. All rights reserved.

Figures

Figure 1

Systolic and diastolic blood pressure distribution among participants in the Chronic Renal Insufficiency Cohort (CRIC) study (n=3612). Abbreviations: SBP – systolic blood pressure; DBP – diastolic blood pressure.

Figure 2

Overall rates of hypertension prevalence, awareness, treatment and control among participants of the Chronic Renal Insufficiency Cohort (CRIC) study. HTN-hypertension (prevalence among all CRIC participants; Aware and Treated are the percent among all participants with hypertension. Hypertension control rates are calculated for all CRIC participants with hypertension.

Figure 3

Number of blood pressure medications being taken by participants and blood pressure control in the Chronic Renal Insufficiency Cohort study.