Assessment of hypertension prevalence and control in patients with chronic kidney disease: evidence from clinical practice data in US

Purposes: Chronic kidney disease (CKD) presents a significant global public health problem through increased risk of cardiovascular events and death. Hypertension (HTN) is a common comorbid condition among CKD patients. Clinical studies have demonstrated that HTN is both a marker and a risk factor of CKD progression. The goal of this study was to measure the prevalence of HTN among CKD patients and to document the demographic and clinical characteristics of hypertensive patients with CKD in the US. Methods: This was a cross-sectional study utilizing a national electronic medical record database (GE Centricity) from 2002-12. Patients with CKD were identified based on reported ICD-9 codes 585.x, 403.x, or 404.x. CKD stages were defined according to the National Kidney Foundation guidelines based on the glomerular filtration rate (GFR. Patients were classified as diagnosed hypertensive if they had either a diagnosis of HTN (ICD-9 codes: 401-405, 255.10) or were treated with antihypertensive agents. Undiagnosed hypertensive patients were those with SBP/DBP levels above 130/80 mmHg and neither diagnosed nor treated. To evaluate blood pressure (BP) control, BP values were assessed based on a minimum of 3 measurements at different times. Results: Of the 159306 patients identified with CKD (mean age 69.8 years, 48.4% male), 5.1%, 28.5%, 58.8%, and 9.6% were classified as CKD stage 1-4 respectively. The prevalence of HTN overall and by stage is provided in the table. Of the 111394 treated hypertensive patients, 27.2% were on monotherapy, while 25.9%, 23.9%, 14.5%, and 8.5% were treated with 2, 3, 4, and 5+ classes of anti-hypertensive medications. Among those treated mean (sd) SBP/DBP was 133 (19.9)/74 (11.7) mmHg with only 36.9% having SBP/DBP less than 130/80 mmHg. Table 1. Prevalence of HTN in CKD Conclusions: HTN is a common comorbidity among CKD patients and remains largely uncontrolled despite the availability of multiple and effective classes of medications. Better management and awareness of the problem may lead to improved outcomes