P-310: Uncontrolled hypertension and chronic kidney disease in the keep study

Abstract

Hypertension is a major modifiable risk factor for renal disease progression. We examined the association of kidney disease (KD) presence and severity with uncontrolled HTN using the Kidney Early Evaluation Program (KEEP) data. KEEP, sponsored by NKF, is a community-based program to identfy people at risk for, or in the early stages of, kidney disease (KD). Persons 18 years of age or older with a personal or family history of hypertension, diabetes and/or KD are recruited by 35 NKF affiliates in 31 states. Hypertension is classified by JNC- VI criteria and CKD according to K/DOQI stage, based on estimated glomerular filtration rate (eGFR) calculated using the MDRD equation, and urine albumin measurements.

Of 10,584 participants with complete data, 44% were African American, 36% white, 5.6% American Indians, and 10% Hispanic. Of those screened, 15% had eGFR <60 ml/min. The prevalence of high blood pressure (≥140/90 mmHg) at screening was 46%, overall, and ranged from 34 to 51% by ethnic and gender groups; compared to the general population, the prevalence of hypertension was 132% higher in African Americans and 151% higher in whites. Of those with a history of hypertension, most had uncontrolled BP (63% overall). Mean systolic blood pressure rose from 132.6 to 148.1 mm Hg from CKD stage I to IV-V, respectively. The prevalence of uncontrolled hypertension, defined as ≥140/90 mmHg, increased stepwise from approximately 40% in stage I CKD to about 73% in stage IV-V. The recommendations for blood pressure control are more stringent in persons with renal disease and/or diabetes. Using ≥135/85 mm Hg as a cutpoint, the prevalence of uncontrolled hypertension was much higher: 58% in stage I and almost 80% in stage IV-V. Anemia was also associated with a higher prevalence of uncontrolled hypertension in analyses stratified by CKD stages, except in stage V.

In conclusion, in this group who are self-identified as high risk for CKD, the prevalence of uncontrolled hypertension is unacceptably high. Prevention efforts to educate and improve treatment of hypertension in this group should be designed and implemented.

Am J Hypertens (2004) 17, 146A–147A; doi: 10.1016/j.amjhyper.2004.03.385

Kidney Disease, Kidney Early Evaluation Program, Hypertension