Abstract: PO2066
Angiotensin Converting Enzyme Inhibitor and Angiotensin Receptor Blocker Use Among Hypertensive US Adults by Albuminuria Status, 2013-2018
Session Information
- Hypertension and CVD: Epidemiology, Risk Factors, and Prevention
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention
Authors
- Chu, Chi D., University of California San Francisco, San Francisco, California, United States
- Powe, Neil R., University of California San Francisco, San Francisco, California, United States
- McCulloch, Charles E., University of California San Francisco, San Francisco, California, United States
- Banerjee, Tanushree, University of California San Francisco, San Francisco, California, United States
- Crews, Deidra C., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Saran, Rajiv, University of Michigan, Ann Arbor, Michigan, United States
- Bragg-Gresham, Jennifer L., University of Michigan, Ann Arbor, Michigan, United States
- Morgenstern, Hal, University of Michigan, Ann Arbor, Michigan, United States
- Pavkov, Meda E., Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Saydah, Sharon, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Tuot, Delphine S., University of California San Francisco, San Francisco, California, United States
Group or Team Name
- CDC CKD Surveillance Team
Background
Since 2003, U.S. hypertension (HTN) guidelines have recommended angiotensin converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) therapy for urine albumin/creatinine ratio (UACR) ≥300 mg/g. Our objective was to assess the prevalence of ACEi/ARB use for UACR ≥300 mg/g among adults with HTN and to examine the association between UACR and ACEi/ARB use.
Methods
We studied adults with HTN in the National Health and Nutrition Examination Surveys 2013-2018. Respondents were classified as having HTN if they had systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg, were currently using anti-hypertensive medications, or reported being told by a clinician they had HTN. ACEi/ARB use was assessed by review of medication containers by study staff. Modified Poisson regression was used to estimate crude and adjusted prevalence ratios (PR) for the association between ACEi/ARB use and UACR; adjustment was for age, sex, race/ethnicity, diabetes, systolic blood pressure (continuous), chronic kidney disease stage, and having a reported routine site for healthcare.
Results
Among 7,377 adults with HTN, 83.4% had UACR 0-29 mg/g, 13.5% had UACR 30-299 mg/g, and 3.2% had UACR ≥300 mg/g. ACEi/ARB use was 43%, 54%, and 48% in UACR categories 0-29, 30-299, and ≥300 mg/g, respectively. This represents approximately 1.5 million adults with UACR ≥300 mg/g who are not receiving ACEi/ARB therapy. Adjusted ACEi/ARB use was minimally associated with UACR ≥30 mg/g (PR = 1.09, 95% CI 1.03-1.17 for UACR 30-299 mg/g; PR = 0.96; 95% CI 0.83-1.10 for UACR ≥300 mg/g; reference = UACR <30 mg/g).
Conclusion
Nationally representative data indicate a large gap in guideline-concordant ACEi/ARB use among adults with HTN and UACR ≥300 mg/g. Improving uptake of ACEi/ARB therapy presents a substantial opportunity for prevention of cardiovascular disease and kidney disease progression for adults with HTN.
Funding
- NIDDK Support