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Abstract: TH-PO225

Blood Pressure Control Before and After the Updated 2017 Guidelines in Patients with Proteinuric Kidney Disease

Session Information

Category: Hypertension and CVD

  • 1602 Hypertension and CVD: Clinical

Authors

  • Weaver, Donald J., Levine Children's Hospital, Charlotte, North Carolina, United States
  • Putnam, Nathaniel, University of Michigan, Ann Arbor, Michigan, United States
  • Robinson, Bruce M., University of Michigan, Ann Arbor, Michigan, United States
  • Salmon, Eloise, University of Michigan, Ann Arbor, Michigan, United States
  • Kamil, Elaine S., Cedars-Sinai Medical Center, Los Angeles, California, United States
  • Adler, Sharon G., University of California Los Angeles, Los Angeles, California, United States
  • Lafayette, Richard A., Stanford Medicine, Stanford, California, United States
  • Massengill, Susan F., Levine Children's Hospital, Charlotte, North Carolina, United States
  • Modi, Zubin J., University of Michigan, Ann Arbor, Michigan, United States

Group or Team Name

  • Kidney Research Network.
Background

We hypothesized that the stricter 2017 ACC/AHA Task Force hypertension (HTN) guidelines led to improved blood pressure control (BPC) in patients with proteinuric renal disease after 2017.

Methods

Data from existing electronic health record documentation for each patient up to May 1, 2022 was extracted on adult patients (≥18) from the Kidney Research Network multi-center electronic health record registry of patients with glomerular disease. Baseline diagnosis of HTN was defined using blood pressure measurements, ICD-9/10 codes, and medication records. BPC was defined as BP < 120/80 for ≥75% of follow-up recordings following hypertension diagnosis. Follow-up was split into two eras, pre-2017 and post-2017. We used generalized linear models with a log odds outcome and an unstructured correlation matrix to evaluate the adjusted association between era and BPC.

Results

In this analysis, 725 patients were included of which 55% were male and median eGFR was 62. Only 6% had normal BP at diagnosis. In the pre-2017 era 10% of patients demonstrated BPC compared to 14% in the post-2017 era. In adjusted analysis, patients were more likely to achieve BPC after 2017, however not statistically significant (OR 1.7; CI 0.96-3.02) (Figure 1). More severe prior HTN and higher medication burden were associated with worse BPC.

Conclusion

In adjusted analyses, BPC improved modestly after 2017. However, BPC in patients with proteinuric CKD remains poor, especially when compared to more recent stricter recommendations. Future analysis with greater follow-up time, and using the most contemporary data possible, are needed to understand opportunities to do more to achieve greater BPC in this population.

Figure 2. Odds of reaching blood pressure control in hypertensive glomerular disease patients