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Abstract: TH-OR104

Trends in Hypertension Control in Those with and Without CKD in the United States: 1999-2016

Session Information

Category: Hypertension and CVD

  • 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention

Authors

  • Vart, Priya, Radboud University, Nijmegen, Netherlands
  • Tummalapalli, Sri Lekha, University of California San Francisco, San Francisco, California, United States
  • Powe, Neil R., Priscilla Chan and Mark Zuckerberg San Francisco Gen Hosp & UCSF, San Francisco, California, United States
  • Bragg-Gresham, Jennifer L., University of Michigan, Ann Arbor, Michigan, United States
  • Saran, Rajiv, University of Michigan, Ann Arbor, Michigan, United States
  • Burrows, Nilka Rios, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Saydah, Sharon, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Crews, Deidra C., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Group or Team Name

  • CDC CKD Surveillance Team
Background

We examined temporal trends in hypertension (HTN) control overall and in those with and without CKD.

Methods

A total of 19,856 adults (≥20 years) with HTN from NHANES 1999-2000 to 2015-2016 were examined. HTN was defined as mean systolic blood pressure (BP) ≥130 or mean diastolic BP ≥80 or anti-hypertension medication use. HTN control was defined as BP <130/80 mmHg among hypertensives (as defined above). Age, sex and race adjusted estimates were obtained using logistic regression analysis. Restricted cubic splines were used to flexibly model trends over time, with predefined knots at 2004, 2008, and 2012. We tested the combined interaction of spline terms with reduced eGFR (<60 ml/min/1.73m2) and elevated albuminuria (ACR ≥30mg/g), separately.

Results

HTN control improved overall between 1999-2000 and 2015-2016, from 9.1% to 25.2% (p<0.001). Greater improvement in HTN control was observed in the period from 1999-2000 to 2007-2008 (12.5%, p<0.001), than thereafter (3.5%, p=0.08). The temporal trend in HTN control differed by reduced eGFR status (p for interaction=0.02). HTN control was comparable in individuals with reduced and non-reduced eGFR until 2007-2008 and thereafter control improved more in those with reduced eGFR (Fig.1A). Difference in HTN control between those with and without reduced eGFR was -2.0% in 1999-2000 (p=0.07), 1.4% in 2007-2008 (p=0.4) and 7.0% in 2015-2016 (p=0.06). The temporal trend in HTN control by albuminuria status was similar to the overall trend (p for interaction=0.5) (Fig.1B). Persons with albuminuria had lower HTN control throughout. Difference in HTN control between those with and without albuminuria was -4.5% in 1999-2000 (p<0.001), -5.9% in 2007-2008 (p<0.001) and -8.5% in 2015-2016 (p=0.001).

Conclusion

Overall, improvement in HTN control has slowed in the last ten years, particularly among persons without reduced eGFR. Those with and without albuminuria experienced a similar trend in HTN control, though HTN control remained consistently lower in persons with albuminuria

Funding

  • Other U.S. Government Support