Treatment and Control of Hypertension Among Adults With Chronic Kidney Disease, 2011 to 2019

Area of Science:

• Nephrology
• Cardiology
• Public Health

Background:

• Hypertension is a common comorbidity and consequence of chronic kidney disease (CKD).
• Understanding contemporary trends in hypertension management within CKD populations is crucial for clinical practice and public health.
• This study investigates hypertension treatment and control in a national sample of US veterans with CKD.

Purpose of the Study:

• To examine trends in blood pressure (BP) control among adults with CKD.
• To analyze trends in antihypertensive medication prescriptions in this population.
• To identify changes in hypertension management strategies over time.

Main Methods:

• Utilized 5% cross-sectional samples of adults with CKD from the Veterans Health Administration (2011-2019).
• Defined CKD by estimated glomerular filtration rate (<60 mL/min/1.73 m²) or urine albumin-to-creatinine ratio (≥30 mg/g).
• Assessed BP control (systolic BP <140 mmHg, diastolic BP <90 mmHg) and antihypertensive medication use.

Main Results:

• Age-adjusted controlled BP proportion in CKD adults declined from 78.0% (2011) to 72.2% (2014), reaching a nadir of 71.0% (2015) before rising to 72.9% (2019).
• Among those with uncontrolled BP, the proportion untreated increased from 18.8% to 21.6%, while those on ≥3 medications decreased from 41.8% to 36.3%.
• Prescriptions for first-line antihypertensive agents also showed a decreasing trend.

Conclusions:

• Hypertension control among CKD patients in the VA system showed an initial decline followed by a slight recovery.
• This trend coincided with a decrease in antihypertensive medication prescriptions, including first-line agents.
• Findings suggest shifts in hypertension management strategies for CKD patients over the study period.