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Trends in using of antihypertensive medication among US CKD adults, NHANES 2001-2018
Fanghua Li1, Anbang Sun2, Feng Wu1
1Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Insights
Blood pressure control remains poor in US adults with chronic kidney disease (CKD). Monotherapy is common, and combination therapy may improve outcomes.
Area of Science:
- Nephrology
- Cardiology
- Public Health
Background:
- Blood pressure (BP) control rates in US adults with chronic kidney disease (CKD) on antihypertensive medications have stagnated over the past decade.
- Many CKD patients require multiple antihypertensive agents to achieve guideline-recommended BP targets.
- Previous studies have not quantified the prevalence of monotherapy versus combination therapy in this population.
Purpose of the Study:
- To investigate trends in BP control rates among US adult CKD patients receiving antihypertensive medication from 2001 to 2018.
- To determine the proportion of CKD patients on antihypertensive monotherapy versus combination therapy.
- To assess changes in the use of specific antihypertensive classes, including ACE inhibitors/angiotensin receptor blockers (ACEi/ARB).
Main Methods:
- Analysis of National Health and Nutrition Examination Survey data from 2001-2018, including 4,453 US adults (age ≥ 20) with CKD on antihypertensive medication.
- Evaluation of BP control rates based on 2021 KDIGO, 2012 KDIGO, and 2017 ACC/AHA guideline targets.
- Assessment of antihypertensive treatment patterns, including monotherapy, dual, triple, and quadruple therapy, and use of ACEi/ARB.
Main Results:
- Uncontrolled BP rates among US adults with CKD on antihypertensives were 81.4% (2001-2006) and 78.2% (2013-2018).
- Monotherapy constituted approximately one-third of antihypertensive regimens, with no significant change observed across study periods (38.6% to 34.6%).
- No significant changes were noted in the proportions of dual, triple, or quadruple therapy; ACEi/ARB use decreased, but not significantly among patients with ACR > 300 mg/g.
Conclusions:
- BP control rates in US adult CKD patients on antihypertensive medications have not improved between 2001 and 2018.
- Monotherapy remains prevalent, accounting for about one-third of treatments, without significant change over time.
- Increasing the use of antihypertensive combination therapy may be a strategy to improve BP control in this patient group.
Objective:
Blood pressure (BP) control rates among adult patients taking antihypertensive medications in the United States have not improved over the last decade. Many CKD adults require more than one class of antihypertensive agent to reach the BP target recommended by the guidelines. However, no study has quantified the proportion of adult CKD patients taking antihypertensive medication who are on monotherapy or combination therapy.
Methods:
National Health and Nutrition Examination Survey data during 2001-2018 was used, including adults with CKD taking antihypertensive medication (age ≥ 20 years, n = 4,453). BP control rates were investigated under the BP targets recommended by the 2021 KDIGO, the 2012 KDIGO, and the 2017 ACC/AHA guidelines.
Results:
The percentages of uncontrolled BP among US adults with CKD taking antihypertensive medication were 81.4% in 2001-2006 and 78.2% in 2013-2018. The proportion of monotherapy of antihypertensive regimen were 38.6, 33.3, and 34.6% from 2001 to 2006, 2007-2012, and 2013-2018, with no obvious difference. Similarly, there was no significant change in percentages of dual-therapy, triple-therapy, and quadruple-therapy. Although proportion of CKD adults not treated with ACEi/ARB decreased from 43.5% in 2001-2006 to 32.7% in 2013-2018, treatment of ACEi/ARB among patients with ACR > 300 mg/g had no significant change.
Conclusion:
The BP control rates among US adult CKD patients taking antihypertensive medications have not improved from 2001 to 2018. Mono-therapy accounted for about one third of adult CKD patients taking antihypertensive medication and not changed. Increasing antihypertensive medication combination therapy may help improve BP control in CKD adults in the United States.
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