Abstract: TH-PO442
CKD Screening Rate and Blood Pressure (BP) Control in Veterans with Hypertension
Session Information
- Hypertension and CVD: Epidemiology, Risk Factors, Prevention
October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention
Authors
- Bansal, Shweta, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
- Leykum, Luci, UTHSCSA, SAN ANTONIO, Texas, United States
- Pugh, Jacqueline, STVHCS, SAN ANTONIO, Texas, United States
Background
Hypertension (HTN) control is a key strategy to prevent CKD progression. Earlier recognition of CKD (by eGFR and albuminuria) and volume optimization using diuretics are important to achieve adequate BP control. Prevalence of CKD is a third higher in Veterans; however, CKD screening rate in hypertensive Veterans, HTN control and utilization of diuretics in Veterans with CKD is unclear.
Methods
We analyzed Veterans Integrated Service Network corporate Data Warehouse for Veterans seen at least twice in primary clinics with ICD-9 codes for HTN and diabetes. The Final cohort of 241,235 subjects was examined for serum creatinine/eGFR reported at least twice 90 days apart, urine protein and ICD-9 for CKD. BP readings from last two clinic visits were averaged to evaluate the HTN control.
Results
Ten percent of final cohort did not have any CKD screening procedures. Figure 1 shows the percentage of hypertensive subjects with (N=92,129) or without diabetes (N=128,099) with available serum creatinine or urine protein measurements or both. CKD (eGFR<60 ml/min and/or ACR>30mg/g) was present in 27.2% subjects but only 6% had CKD ICD-9 code in the chart. Table 1 demonstrates the HTN control and baseline characteristics in these 27.2% subjects.
Conclusion
While hypertensive Veterans get eGFR checked, identification of albuminuria is suboptimal and despite screening procedures the recognition of CKD is low. Only one third CKD Veterans had BP <130/80 mmHg and 29% were on diuretics. These results warrant exploration of factors responsible for these low rates and design interventions to address those factors to improve HTN control.
| BP<130/80 mmHg N=22013 (37.5%) | BP 130-140/80-90 mmHg N=17839 (30.4%) | BP>140/90 mmHg N=18915 (32.2%) | p value | |
| SBP/DBP mmHg | 118.02 ± 9.38/66.13 ± 7.30 | 133.71 ± 4.7/74.28 ± 8.13 | 153.00 ± 12.46/79.78 ± 10.53 | |
| Age (Yr) | 70.46 ± 11.00 | 68.51 ± 11.19 | 68.91 ± 11.38 | <0.001 |
| Race (%): Hispanic Black White Asian | - 10.3 29.8 59.24 0.17 | - 11.6 19.7 54.3 0.17 | - 12.3 23 49.8 0.21 | <0.001 |
| Medications (%): ACEI/ARB Diuretics Beta Blocker CaCh Blocker Alpha Blocker Others | - 62.8 32.6 51.0 34 17.9 7.49 | - 64.8 25.1 45.7 51.4 17.9 12.2 | - 69.7 29.7 51.5 63.4 15.5 21.3 | <0.001 |
Funding
- Veterans Affairs Support