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Abstract: PO2066

Angiotensin Converting Enzyme Inhibitor and Angiotensin Receptor Blocker Use Among Hypertensive US Adults by Albuminuria Status, 2013-2018

Session Information

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