Hypertension Awareness, Treatment, and Control in Chronic Kidney Disease

doi:10.1016/j.amjmed.2007.11.025

The American Journal of Medicine

Volume 121, Issue 4, April 2008, Pages 332-340

https://doi.org/10.1016/j.amjmed.2007.11.025 Get rights and content

Abstract

Background

Hypertension prevalence, awareness, treatment, and blood pressure control rates in the population with chronic kidney disease are limited. The objective of this study was to determine the state of blood pressure control in patients with chronic kidney disease.

Methods

This is a cross-sectional analysis of data of participants with chronic kidney disease from the Kidney Early Evaluation Program. The Kidney Early Evaluation Program is a national-based health screening program for individuals at high risk for kidney disease conducted in 49 states and the District of Columbia. Of 55,220 adults with kidney disease, 10,813 completed information for demographic and medical characteristics used in the analysis. Predictors of blood pressure control were assessed using multiple logistic regression analysis.

Results

Hypertension prevalence, awareness, and treatment proportions in the screened cohort were high (86.2%, 80.2%, and 70.0%, respectively), but blood pressure control rates were low (13.2%). These proportions increased with advancing stage of kidney disease. Elevated systolic blood pressure accounted for the majority of inadequate control. Male gender (odds ratio [OR] 0.86; 95% confidence interval [CI], 0.75-0.99), non-Hispanic black race (OR 0.76; 95% CI, 0.65-0.89), and body mass index of 30 kg/m² or more (OR 0.83; 95% CI, 0.73-0.94) were inversely related with blood pressure control. Those with stage 3 kidney disease were more likely to have blood pressure at goal than those with stage 1 kidney disease (OR 2.08; 95% CI, 1.55-2.80).

Conclusion

We conclude that despite increased awareness and treatment of hypertension, control rates in these participants are poor. This poor control rate centers around elevated systolic pressure in people who are obese, non-Hispanic black, or male. These data suggest that those who are aware of their kidney disease are more likely to achieve blood pressure control.

Section snippets

Study Population

The KEEP program is a nationwide effort by the National Kidney Foundation to evaluate and educate people at high risk for chronic kidney disease, that is, adult individuals with a history of diabetes or hypertension or a family history of these diseases. The program was officially launched in August of 2000, and by the end of 2005, some 55,220 individuals were screened in 49 states and the District of Columbia.¹⁰ The present study is a cross-sectional analysis including all KEEP participants

Demographic and Clinical Characteristics

A total of 10,813 of 55,220 KEEP participants (19.6%) were included in the present study (Figure 1). A summary of demographic and clinical characteristics of KEEP participants who were evaluated for study selection is presented in Table 1. The demographic and clinical characteristics of the chronic kidney disease cohort evaluated are presented in Table 2. Awareness of chronic kidney disease in this cohort was as low as 6.5%.

Hypertension Awareness, Treatment, and Control

Eighty-six percent of the study cohort were identified as hypertensive

Discussion

Our data demonstrate that in a cohort of patients with chronic kidney disease the prevalence, awareness, and treatment of hypertension was comparable, if not better, than in NHANES 2003-2004,²² but that the blood pressure control rate was far worse than in NHANES. Elevated systolic blood pressure accounted for most of the cases of inadequate control. Male gender, non-Hispanic black race, and obesity were associated with a greater likelihood that blood pressure would not be controlled, whereas

Conclusions

This is the first study to provide data on the prevalence, awareness, and treatment of hypertension in a cohort with chronic kidney disease. Hypertension control rates were lower than in the general population, primarily driven by elevated systolic blood pressure. Achievement of blood pressure goals improves as awareness of advancing kidney disease stage is apparent. Because the presence of advanced kidney disease is the most common cause of medically treatable hypertension,³⁴ current

References (34)

L.U. Mailloux et al.
Hypertension in the ESRD patient: pathophysiology, therapy, outcomes, and future directions
Am J Kidney Dis
(1998)
P.A. Sarafidis et al.
Antihypertensive therapy in the presence of proteinuria
Am J Kidney Dis
(2007)
W.W. Brown et al.
Early detection of kidney disease in community settings: the Kidney Early Evaluation Program (KEEP)
Am J Kidney Dis
(2003)
P. Verdecchia et al.
White coat hypertension and white coat effectSimilarities and differences
Am J Hypertens
(1995)
N. Khosla et al.
Microalbuminuria
Clin Lab Med
(2006)
I. Hajjar et al.
Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988-2000
JAMA
(2003)
K. Wolf-Maier et al.
Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States
JAMA
(2003)
World Health Report 2002: Reducing Risks, Promoting Healthy Life
(2002)
P.A. McCullough et al.
Independent components of chronic kidney disease as a cardiovascular risk state: results from the Kidney Early Evaluation Program (KEEP)
Arch Intern Med
(2007)
KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease
Am J Kidney Dis
(2007)

J. Coresh et al.

Chronic kidney disease awareness, prevalence, and trends among U.S. adults, 1999 to 2000

J Am Soc Nephrol

(2005)

C.Y. Hsu et al.

The incidence of end-stage renal disease is increasing faster than the prevalence of chronic renal insufficiency

Ann Intern Med

(2004)

P.A. Sarafidis et al.

Microalbuminuria and chronic kidney disease as risk factors for cardiovascular disease

Nephrol Dial Transplant

(2006)

A.S. Go et al.

Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization

N Engl J Med

(2004)

Kidney Early Evaluation ProgramAnnual Data Report 2006

Am J Kidney Dis

(2007)

K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease

Am J Kidney Dis

(2004)

A.V. Chobanian et al.

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report

JAMA

(2003)

Cited by (246)

Awareness of Hypertension in Reproductive-Aged Women Living With Chronic Kidney Disease
2024, CJC Open
Hypertension is the most important modifiable cardiovascular risk factor among women. Chronic kidney disease (CKD), which affects 1 in 10 reproductive-aged women, increases the risk of hypertension; however, awareness of hypertension in this population is unknown. This study aimed to determine hypertension awareness among reproductive-aged women living with chronic kidney disease.
Women aged 18 to 50 years with CKD were recruited from nephrology clinics in Calgary, Alberta, Canada. Participants completed a semistructured interview and focused chart review, serum and urine laboratory assessment, and a physical examination that included anthropomorphic measurements and 2 automated office blood pressure readings. Hypertension was defined according to the use of ≥ 1 antihypertensive medications and/or an automated office blood pressure reading of ≥ 135/85 mm Hg. Data were stratified by hypertension status, as well as by awareness, and descriptively presented as mean ± standard deviation, numerical values, and percentages.
Sixty-three participants with CKD were included. Thirty-eight (60%) participants had hypertension according to study definitions. Of those with hypertension, 30 participants (79%) were aware of their hypertension status.
Hypertension awareness is relatively high in reproductive-aged women living with CKD. However, hypertension awareness is the critical component for hypertension management, and further work is necessary to optimize reduction of cardiovascular risk in this important population.
L’hypertension est le principal facteur de risque cardiovasculaire modifiable chez les femmes. La néphropathie chronique, qui touche une femme en âge de procréer sur 10, augmente le risque d’hypertension, mais le niveau de sensibilisation de cette population à ce sujet est inconnu. La présente étude visait à déterminer le niveau de sensibilisation à l’hypertension chez les femmes en âge de procréer atteintes de néphropathie chronique.
Des femmes âgées de 18 à 50 ans atteintes de néphropathie chronique ont été recrutées dans les cliniques de néphrologie de Calgary, en Alberta (Canada). Les participantes ont été soumises à des entrevues semi-structurées, un examen ciblé du dossier médical, des analyses de laboratoire du sérum et de l’urine et un examen physique incluant des mesures anthropométriques et deux lectures automatisées de la pression artérielle réalisées en cabinet. L’hypertension a été définie de la façon suivante : (1) l’utilisation de ≥ 1 agent antihypertenseur, et/ou (2) une lecture automatisée de la pression artérielle en cabinet ≥ 135/85 mmHg. Les données ont été stratifiées selon le statut d’hypertension et le niveau de sensibilisation, et elles sont présentées de façon descriptive par la moyenne ± l’écart-type, les valeurs numériques et les pourcentages.
Soixante-trois participantes atteintes de néphropathie chronique ont été incluses dans l’étude. Trente-huit (60 %) participantes étaient atteintes d’hypertension selon la définition utilisée dans l’étude. Parmi les participantes hypertendues, 30 (79 %) étaient conscientes de leur statut d’hypertension.
Le niveau de sensibilisation à l’hypertension est relativement élevé parmi les femmes en âge de procréer atteintes de néphropathie chronique. Toutefois, la sensibilisation à l’hypertension est un élément clé pour sa prise en charge, et d’autres travaux sont nécessaires pour optimiser la réduction du risque cardiovasculaire dans cette population importante.
Effects of Sodium-Specific Medical Nutrition Therapy from a Registered Dietitian Nutritionist in Individuals with Chronic Kidney Disease: An Evidence Analysis Center Systematic Review and Meta-Analysis
2022, Journal of the Academy of Nutrition and Dietetics
Dietary sodium intake can increase risk of hypertension, a leading cause of kidney failure in individuals with chronic kidney disease. The objective of this systematic review was to examine the effect of sodium-specific medical nutrition therapy provided by a registered dietitian nutritionist or international equivalent on blood pressure and urinary sodium excretion in individuals with chronic kidney disease, stages 2 through 5, receiving maintenance dialysis and posttransplant. Medline, the Cumulative Index to Nursing and Allied Health Literature, Cochrane Cochrane Central Register of Controlled Trials, and other databases were searched to identify eligible controlled trials published in the English language from January 2000 until June 2020 that addressed the research question. Risk of bias was assessed using the RoB 2.0 tool and quality of evidence was examined by outcome using the Grading of Recommendations Assessment, Development, and Evaluation method. Of the 5,642 articles identified, eight studies were included in the final analyses. Six studies targeted clients who were not dialyzed, including one with clients who were posttransplantation, and two studies with clients receiving maintenance hemodialysis. Sodium-specific medical nutrition therapy from a registered dietitian nutritionist significantly reduced clinic systolic blood pressure (mean difference –6.7, 95% CI –11.0 to –2.4 mm Hg; I² = 51%) and diastolic blood pressure (mean difference –4.8, 95% CI, –7.1 to –2.4 mm Hg; I² = 23%) as well as urinary sodium excretion (mean difference –67.6, 95% CI –91.6 to –43.6 mmol/day; I² = 84.1%). Efficacy was limited to individuals who were not dialyzed, including posttransplantation, but the intervention did not significantly improve blood pressure in individuals receiving maintenance hemodialysis. Adults with chronic kidney disease should begin to work with registered dietitian nutritionist early in the course of disease to receive individualized, effective counseling to improve risk factors and, ultimately, health outcomes.
Thromboxane A<inf>2</inf> is involved in the development of hypertension in chronic kidney disease rats
2021, European Journal of Pharmacology
Citation Excerpt :
Controlling blood pressure is key for delaying progression of CKD (Bakris et al., 2000; Hilgers, 2013). However, with the prevalence rate of hypertension in CKD patients around 85%, efforts to control hypertension have clearly been unsatisfactory (Sarafidis et al., 2008; Muntner et al., 2010). The pathogenesis of hypertension in CKD patients is so complex and multifactorial that it is resistant to treatment (Campese et al., 2006).
Hypertension is one of the most common complications of chronic kidney disease (CKD). Some research has indicated that changes in large artery function especially caused by thromboxane A2 (TXA2) may be a novel factor acting to induce hypertension in CKD. We studied the 5/6 nephrectomy rat model and measured serum levels of creatinine (Cr), calcium (Ca), phosphorus (P), TXA2-stable metabolites (thromboxane B2, TXB2), and caudal artery pressure after nephrectomy. The tension variations in thoracic aortas were measured after stimulating by vasoconstrictor/vasodilator using the cumulative concentration administration method and then tested the expression of TXA2 receptors in the thoracic aortas through western blots. The CKD rats developed uremia, electrolyte imbalances，and hypertension. They also exhibited a significant increase in TXB2 concentration. The aortic rings of CKD rats showed an increased contraction response to U46619 (a TXA2 analogue) and the expression of TXA2 receptors also enhanced. In the meanwhile, the diastolic function decreased in the CKD group. Our results demonstrate that the impairment of artery contractile function caused by the increase of TXA2 receptors on the wall of aortic rings may be involved in hypertension in CKD rats.
Gut microbial metabolites SCFAs and chronic kidney disease
2024, Journal of Translational Medicine
Association of the Intensive Blood Pressure Target and Cardiovascular Outcomes in the Population With Chronic Kidney Disease: A Retrospective Study in Korea
2024, Journal of the American Heart Association
Use of ACEi/ARBs, SGLT2 inhibitors and MRAs can help us reach the therapeutic ceiling in CKD
2024, Clinical Kidney Journal

View all citing articles on Scopus

: The authors declare no conflicts related to the present study.

View full text

Clinical research studyHypertension Awareness, Treatment, and Control in Chronic Kidney Disease

Abstract

Background

Methods

Results

Conclusion

Section snippets

Study Population

Demographic and Clinical Characteristics

Hypertension Awareness, Treatment, and Control

Discussion

Conclusions

Am J Kidney Dis

Am J Kidney Dis

Am J Kidney Dis

Am J Hypertens

Clin Lab Med

Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988-2000

JAMA

Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States

JAMA

World Health Report 2002: Reducing Risks, Promoting Healthy Life

Independent components of chronic kidney disease as a cardiovascular risk state: results from the Kidney Early Evaluation Program (KEEP)

Arch Intern Med

KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease

Am J Kidney Dis

Chronic kidney disease awareness, prevalence, and trends among U.S. adults, 1999 to 2000

J Am Soc Nephrol

The incidence of end-stage renal disease is increasing faster than the prevalence of chronic renal insufficiency

Ann Intern Med

Microalbuminuria and chronic kidney disease as risk factors for cardiovascular disease

Nephrol Dial Transplant

Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization

N Engl J Med

Kidney Early Evaluation ProgramAnnual Data Report 2006

Am J Kidney Dis

K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease

Am J Kidney Dis

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report

JAMA

Clinical research study
Hypertension Awareness, Treatment, and Control in Chronic Kidney Disease