During an oral presentation at Kidney Week 2019, researchers led by Priya Vart, PhD, reported results of an analysis designed to examine temporal trends in hypertension control overall and in individuals with and without chronic kidney disease (CKD). The session was titled Trends in Hypertension Control in Those with and without CKD in the United States: 1999-2016.
The analysis included data on 19,856 adults ≥20 years of age with hypertension from the National Health and Nutrition Examination Survey 1999-2000 to 2015-2016.
Hypertension was defined as mean systolic blood pressure ≥130 or mean diastolic blood pressure ≥80 or use of anti-hypertensive medication. Hypertension control was defined as blood pressure <130/80 mmHg among patients defined as hypertensive. Logistic regression analysis was used to determine estimated adjusted for age, sex, and race. Trends over time were modeled using restricted cubic splines with predefined knots at 2004, 2008, and 2012. The researchers tested the combined interaction of spline terms with reduced estimated glomerular filtration rate (eGFR) (<60 mL/min/1.73 m2) and elevated albuminuria (albumin to creatinine ratio ≥30 mg/g) separately.
Between 1999-2000 and 2015-2016, hypertension control improved overall, from 9.1% to 25.2% (P<.001). In the periods 1999-2000 and 2007-2008, the improvement in hypertension control was greater (12.5%; P<.001) than thereafter (3.5%; P=.08). The temporal trend in hypertension control differed by reduced eGFR status (P for interaction, .02). Until 2007-2008, hypertension control was comparable in individuals with reduced and non-reduced eGFR; thereafter, control improved more in patients with reduced eGFR.
The difference in hypertension control between those with and those without reduced eGFR was –2.0% in 1999-2000 (P=.07), 1.4% in 2007-2008 (P=.4), and 7.0% in 2015-2016 (P=.06). The temporal trend in hypertension control by albuminuria status was similar to the overall trend (P for interaction, 0.5), Those with albuminuria had lower hypertension control throughout. The difference in hypertension control between those with and those without albuminuria was –4.5% in 1999-2000 (P<.001), –5.9% in 2007-2008 (P<.001), and –8.5% in 2015-2016 (P=.001).
In conclusion, the researchers said, “Overall, improvement in hypertension control has slowed in the last 10 years, particularly among persons without reduced eGFR. Those with and without albuminuria experienced a similar trend in hypertension control, though hypertension control remained consistently lower in persons with albuminuria.”
Source: Vart P, Tummalapalli SL, Powe NR, et al. Trends in hypertension control in those with and without CKD in the United States: 1999-2016. Abstract of an oral presentation during the American Society of Nephrology Week 2019 (Abstract TH-OR104), November 7, 2019, Washington, DC.