Abstract Body (Do not enter title and authors here): Introduction
The prevalence of uncontrolled hypertension (HTN) remains high in the United States (US), despite the availability of multiple oral antihypertensive medications. Given the bidirectional relationship between high blood pressure (BP) and chronic kidney disease (CKD), future research and care models would benefit from understanding the characteristics and mortality of adults with both uncontrolled HTN and CKD.
Research Questions
This study aimed to estimate the prevalence of CKD among US adults with uncontrolled HTN and to compare the sociodemographic characteristics, clinical characteristics, and mortality between those with and without CKD.
Methods
We utilized data from the US National Health and Nutrition Examination Survey (NHANES) 2013-2018 (baseline) and linked it to the National Death Index as of December 31, 2019 (follow-up). Adults with uncontrolled HTN, defined as average BP ≥130/80 mm Hg with a prescription of ≥1 antihypertensive medication, at baseline were included. CKD was defined using estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m² at baseline. We used logistic regression models to compare characteristics at baseline and Cox proportional hazards models to compare mortality at follow-up between those with and without CKD.
Results
Among 2,813 adults (weighted: 33 million) with uncontrolled HTN, the prevalence of CKD was 15.6%. Independent of age and sex, adults with CKD were more likely to have BP ≥140/90 mm Hg (adjusted odds ratio 1.5 [95% confidence interval: 1.2-2.0]), prescribed ≥3 antihypertensive medications (1.5 [1.2-2.0]), have higher prevalence of any cardiovascular disease (CVD, 1.5 [1.1-1.9]), heart failure (2.2 [1.6-3.0]), and diabetes (1.4 [1.1-1.8]) than those without CKD. They were also more likely to have ≥1 hospitalization (1.6 [1.2-2.2]) and ≥6 healthcare visits (1.6 [1.2-2.1]) in the past year, compared to those without CKD. Furthermore, independent of age and sex, the risk of all-cause, CVD-related, and heart disease-related mortality at follow-up was 2.2 (1.6-2.9), 4.5, (2.3-8.5), and 5.6 (2.3-13.8) times higher in adults with CKD than in those without CKD, respectively.
Conclusions
Our study results highlight that nearly 1 in 6 US adults with uncontrolled HTN were affected by CKD. In addition, CKD was associated with a greater mortality risk. Future investigations and better care models are needed to manage adults with both uncontrolled HTN and CKD.