Trends of Blood Pressure Control in Chronic Kidney Disease Among US Adults: Findings From NHANES 2011 to 2020.

Background: Hypertension afflicts most patients with chronic kidney disease (CKD) and contributes to kidney disease progression, cardiovascular disease, and death in this patient population. The evidence and clinical guidelines support lowering blood pressure (BP) goals in patients with CKD. We evaluated if BP control improved among US adults with CKD.

Methods And Results: In the NHANES (National Health and Nutrition Examination Survey) for the periods 2011 to 2014, 2015 to 2016, and 2017 to 2020, we identified individuals with CKD defined as estimated glomerular filtration rate 20 to 59 mL/min per 1.73 m or urinary albumin/creatinine ratio≥30 mg/g. The following systolic BP categories were evaluated: <120, 120 to 129, 130 to 139, and ≥140 mm Hg. All measures were tested for differences between year groups accounting for sample strata, clusters, and weights. During the periods of 2011 to 2014, 2015 to 2016, and 2017 to 2020, the prevalence of CKD was stable at 14%, 13%, and 13%, respectively (=0.4). Among those with CKD, the proportion of individuals with self-reported hypertension or taking BP medications increased from 66 in 2011 to 2014, to 69 and 86% in 2015 to 2016 and 2017 to 2020, respectively (<0.0001). Although the number of BP medications prescribed increased significantly over time, less than half of the individuals with CKD had well-controlled BP based on the current guidelines.

Conclusions: Although BP recognition has improved among those with CKD, a significant number of individuals with CKD do not meet their BP goal.