Trends in Blood Pressure Control in US Adult CKD Patients from 1999 to 2018.

Background: Blood pressure (BP) control can slow down the progression of chronic kidney disease (CKD) and protect against cardiovascular diseases, significantly improving patient survival. Herein, we analyzed the changes in BP control in adult CKD patients with hypertension in the United States from 1999-2000 to 2017-2018. Methods: National Health and Nutrition Examination Survey (NHANES) data from 1999-2000 to 2017-2018 were analyzed, including 5,510 adult CKD patients with BP above 140/90 mmHg or those under an antihypertensive regimen. Results: The proportion of adult CKD patients with uncontrolled BP decreased from 72.9% in 1999-2000 to 46.6% in 2013-2014, then increased to 56.9% in 2017-2018. Although adult CKD patients with albumin-creatinine rate (ACR) 30-299 mg/g or ACR ≥300 mg/g were more likely to take antihypertensive medication than those with ACR <30 mg/g (PR: 2.76, 95% CI: 1.63-4.79 and PR: 4.59, 95% CI: 2.37-9.51), they were more likely to have uncontrolled BP than those with ACR <30 mg/g ((multivariable-adjusted prevalence ratio (PR): 2.25, 95% CI: 1.39-3.75 and PR: 3.14, 95% CI: 1.71-6.07). Adult CKD patients (eGFR ≥60 mL/min/1.73m2) being aware of their high BP diagnosis were less likely to take antihypertensive medication than those with eGFR 30-59 mL/min/1.73m2 (PR: 0.27, 95% CI: 0.09-0.65). Conclusions: These results show that BP control should be reinforced in adult CKD patients, particularly in those with ACR ≥300 mg/g, while patients with eGFR ≥60 mL/min/1.73m2 should enhance awareness of taking antihypertensive medication.