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Kidney Week

Abstract: PO2298

Although Provider Awareness Is High, More Than Half of US Veterans with CKD Being Treated for Hypertension (HTN) Are Not Meeting Blood Pressure (BP) Targets

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Bragg-Gresham, Jennifer L., University of Michigan Medical School, Ann Arbor, Michigan, United States
  • Steffick, Diane, University of Michigan Medical School, Ann Arbor, Michigan, United States
  • Zhang, Xiaosong, University of Michigan Medical School, Ann Arbor, Michigan, United States
  • Crews, Deidra C., Johns Hopkins University, Baltimore, Maryland, United States
  • Powe, Neil R., University of California San Francisco, San Francisco, California, United States
  • Koyama, Alain, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Burrows, Nilka Rios, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Zivin, Kara, Veterans Health Administration, Ann Arbor, Michigan, United States
  • Saran, Rajiv, University of Michigan Medical School, Ann Arbor, Michigan, United States
Background

HTN is a leading cause of kidney failure in the U.S. In people with CKD, BP control is critical to slow progression to kidney failure. We sought to assess HTN awareness among providers and BP control among Veterans with HTN and CKD.

Methods

We estimated both provider awareness (ICD code for HTN) and BP control (≤130/80 mmHg, ACC 2017) among ~12 million US Veterans between 2006 and 2018, aged 18+, with CKD and HTN, with 1+ outpatient visit each year. Veterans were determined to have CKD if they had either 1) an ICD diagnosis code, 2) eGFR < 60 ml/min/1.73m2, and/or 3) urinary albumin-to-creatinine ratio 30+ mg/g; HTN if they had 1) a diagnosis, 2) were taking BP lowering medication, and/or 3) BP > 130/80. Treatment was defined as a prescription for BP lowering medication.

Results

From 2006 to 2018, ~94% of US veterans with CKD and HTN had a health provider-documented diagnosis code of HTN. The percentage of veterans with diagnosed HTN who were on BP-lowering medications, but did not have their BP under control (BP > 130/80 mmHg) declined from 57.6% to 51.3%. The percentage who had their BP under control increased from 30.2% in 2006 to 32.5% in 2010 but declined to 25.2% in 2018. The percentage with diagnosed HTN who were not receiving BP-lowering medications rose from 5.9% to 17.4%. The percentage of veterans with CKD and high BP who did not have a diagnosis of HTN remained between 5% and 6% throughout.

Conclusion

Provider awareness of HTN in the setting of an integrated health care system is high, as indicated by patients’ recorded diagnosis of HTN. However, despite this high level of provider awareness, more than 50% of patients with diagnosed HTN in 2018 were not achieving the BP target of ≤130/80 mmHg, reflecting the difficulty in controlling BP in CKD patients. A better understanding of underlying factors, along with designing and implementing quality improvement programs may help improve this practice gap.

Funding

  • Other U.S. Government Support