on May 26, 2009
Published online before print May 26, 2009, doi: 10.1161/HYPERTENSIONAHA.109.129841
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Submitted on January 27, 2009
From the Departments of Epidemiology (L.C.P., N.R.P.) and Health Policy and Management (N.R.P.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md; Department of Medicine (E.R.M., N.R.P.), Johns Hopkins School of Medicine, Baltimore, Md; Department of Medicine (L.A.S.), Tufts Medical Center, Boston, Mass; Department of Medicine (R.S.) and Department of Biostatistics, School of Public Health (K.M.), University of Michigan, Ann Arbor; and the Divisions of Adult and Community Health (N.F.) and Diabetes Translation (L.G.), Centers for Disease Control and Prevention, Atlanta, Ga. * To whom correspondence should be addressed. E-mail: plantingal{at}medsfgh.ucsf.edu.
Abstract—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 follows: general definition, systolic blood pressure
Revised on February 14, 2009
Blood Pressure Control Among Persons Without and With Chronic Kidney Disease. US Trends and Risk Factors 1999–2006
Laura C. Plantinga*;
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 m2) 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 definition: P=0.122] and 68.8% versus 51.7% [disease-specific definition: P<0.001]). In those with chronic kidney disease, there were significant decreases in uncontrolled blood pressure over time (55.9% to 47.8% [general definition: P=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.
Key words: blood pressure control • prevalence • trends • risk factors • treatment guidelines • chronic kidney disease
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Hypertension 2009 54: 25-26.
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