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Hypertension Awareness, Treatment, and Control in Adults With CKD: Results From the Chronic Renal Insufficiency Cohort (CRIC) Study
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Background A low rate of blood pressure control has been reported in patients with chronic kidney disease (CKD). These data were derived from population-based samples with a low rate of CKD awareness.Study design Cross-sectional.Setting & participants Data from the baseline visit of the Chronic Renal Insufficiency Cohort (CRIC) Study (n = 3,612) were analyzed. Participants with an estimated glomerular filtration rate of 20-70 mL/min/1.73 m(2) were identified from physician offices and review of laboratory databases.Outcomes Prevalence and awareness of hypertension, treatment patterns, control rates, and factors associated with hypertension control.Measurements Following a standardized protocol, blood pressure was measured 3 times by trained staff, and hypertension was defined as systolic blood pressure > or =140 mm Hg and/or diastolic blood pressure > or =90 mm Hg and/or self-reported antihypertensive medication use. Patients' awareness and treatment of hypertension were defined using self-report, and 2 levels of hypertension control were evaluated: systolic/diastolic blood pressure <140/90 and <130/80 mm Hg.Results The prevalence of hypertension was 85.7%, and 98.9% of CRIC participants were aware of this diagnosis and 98.3% were treated with medications, whereas 67.1% and 46.1% had hypertension controlled to <140/90 and <130/80 mm Hg, respectively. Of CRIC participants with hypertension, 15%, 25%, 26%, and 32% were using 1, 2, 3, and > or =4 antihypertensive medications, respectively. After multivariable adjustment, older patients, blacks, and those with higher urinary albumin excretion were less likely, whereas participants using angiotensin-converting enzyme inhibitors and angiotensin receptor blockers were more likely to have controlled their hypertension to <140/90 and <130/80 mm Hg.Limitations Data were derived from a single study visit.Conclusions Despite almost universal hypertension awareness and treatment in this cohort of patients with CKD, rates of hypertension control were suboptimal.
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“Difficulty controlling BP in late stages of CKD was also seen in CRIC (Chronic Renal Insufficiency Cohort), in which 88% of participants had stage 3 or 4 CKD.”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [303]
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“4 Traditional risk factors such as hypertension, diabetes, and atrial fi brillation are all highly prevalent in patients with CKD, but nontraditional CKD-related risk factors such as chronic in fl ammation, uremic toxins, and oxidative stress are also purported to contribute to risk by triggering vascular injury and end…”
BackgroundInfluentialCentral Pulse Pressure in Chronic Kidney Disease
Townsend, R. R., Chirinos, J. A., Parsa, A., Weir, M. A., Sozio, S. M., Lash, J. P., Chen, J., Steigerwalt, S. P., Go, A. S., Hsu, C., et al. (2010) · Hypertension · doi:10.1161/hypertensionaha.110.153924 · Cited by 47
Self-citationManaging Diabetes and Cardiovascular Risk in Chronic Kidney Disease Patients
Lovre, D., Shah, S., Sihota, A., & Fonseca, V. A. (2017) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2017.10.006 · Cited by 49
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Bakris, G. L., YANG, Y. F. F., & Pitt, B. (2020) · Hypertension · doi:10.1161/hypertensionaha.120.15199 · Cited by 48
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Blood Pressure Indexes and End-Stage Renal Disease Risk in Adults With Chronic Kidney Disease
Bell, E. K., Gao, L., Judd, S. E., Glasser, S. P., McClellan, W., Gutiérrez, O. M., Safford, M. M., Lackland, D. T., Warnock, D. G., & Muntner, P. (2012) · American Journal of Hypertension · doi:10.1038/ajh.2012.48 · Cited by 43
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Time-Centered Approach to Understanding Risk Factors for the Progression of CKD
Ku, E., Johansen, K. L., & McCulloch, C. E. (2018) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.10360917 · Cited by 43
Badin, Y. V., Fomin, I. V., Belenkov, Y. N., Mareev, V. Y., Ageev, F. T., Polyakov, D. S., Геннадьевна, А. Е., Galyavich, A. S., Ionova, T. S., Kamalov, G., et al. (2019) · Kardiologiia · doi:10.18087/cardio.2445 · Cited by 47
Altun, B., Süleymanlar, G., Utaş, C., Arınsoy, T., Ateş, K., Ecder, T., Çamsarı, T., & Serdengeçtı, K. (2012) · Kidney & Blood Pressure Research · doi:10.1159/000339025 · Cited by 42
The Complex Relationship Between CKD and Ambulatory Blood Pressure Patterns
Sinha, A. D., & Agarwal, R. (2015) · Advances in Chronic Kidney Disease · doi:10.1053/j.ackd.2015.01.003 · Cited by 42
Zheng, Y., Cai, G., Chen, X., Fu, P., Chen, J., Ding, X., Yu, X., Lin, H., Liu, J., Xie, R., et al. (2013) · Chinese Medical Journal · doi:10.3760/cma.j.issn.0366-6999.20130835 · Cited by 40
Thiazide Diuretics in Chronic Kidney Disease
Sinha, A. D., & Agarwal, R. (2015) · Current Hypertension Reports · doi:10.1007/s11906-014-0525-x · Cited by 41
Schneider, M. P., Hilgers, K. F., Schmid, M. C., Hübner, S., Nadal, J., Seitz, D., Busch, M., Haller, H. G., Köttgen, A., Kronenberg, F., et al. (2018) · PLoS ONE · doi:10.1371/journal.pone.0202604 · Cited by 41
Blood Pressure Pattern and Target Organ Damage in Patients With Chronic Kidney Disease
Scheppach, J. B., Raff, U., Toncar, S., Ritter, C. O., Klink, T., Störk, S., Wanner, C., Schlieper, G., Saritas, T., Reinartz, S. D., et al. (2018) · Hypertension · doi:10.1161/hypertensionaha.118.11608 · Cited by 39
Blood Pressure Measurement: A KDOQI Perspective
Drawz, P. E., Beddhu, S., Kramer, H., Rakotz, M., Rocco, M. V., & Whelton, P. K. (2019) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2019.08.030 · Cited by 43
A systematic review and meta-analysis of murine models of uremic cardiomyopathy
Soppert, J., Frisch, J., Wirth, J., Hemmers, C., Boor, P., Kramann, R., Vondenhoff, S., Moellmann, J., Lehrke, M., Hohl, M., et al. (2021) · Kidney International · doi:10.1016/j.kint.2021.10.025 · Cited by 38
Renal denervation in patients with chronic kidney disease: current evidence and future perspectives
Schmieder, R. E. (2023) · Nephrology Dialysis Transplantation · doi:10.1093/ndt/gfac189 · Cited by 39
Brazilian Guidelines of Hypertension – 2025
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Sex Disparities in Risk of Mortality Among Children With ESRD
Ahearn, P. C., Johansen, K. L., McCulloch, C. E., Grimes, B. A., & Ku, E. (2018) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2018.07.019 · Cited by 37
Underdiagnosis of Primary Aldosteronism: A Review of Screening and Detection
Hernandez, M. F., & Bhalla, V. (2023) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2023.01.447 · Cited by 36
Poor Awareness of Hypertension in France: The CONSTANCES Population-Based Study
Fenech, G., Vallée, A., Cherfane, M., Kab, S., Goldberg, M., Zins, M., & Blacher, J. (2020) · American Journal of Hypertension · doi:10.1093/ajh/hpaa018 · Cited by 36
Epidemiology of comorbidities in patients with hypertension
Shrestha, P. L., Shrestha, P. A., & Vivo, R. P. (2016) · Current Opinion in Cardiology · doi:10.1097/hco.0000000000000298 · Cited by 35
Metadata
- Authors
- Muntner, P., Anderson, A., Charleston, J., Chen, Z., Ford, V., Makos, G., O'Connor, A., Perumal, K., Rahman, M., Steigerwalt, S., Teal, V., Townsend, R., Weir, M., & Wright, J. T.
- Affiliations
- University of Alabama at Birmingham (US)
- University of Pennsylvania (US)
- University of Maryland, Baltimore (US)
- National Institutes of Health (US)
- University of Illinois Chicago (US)
- University Hospitals Cleveland Medical Center (US)
- St. John Medical Center (US)
- Case Western Reserve University (US)
- Corresponding author
- Muntner, Paul
- ORCID
- Venue
- American Journal of Kidney Diseases
- Publisher
- Elsevier BV
- Published
- 2010-03
- Volume
- 55
- Issue
- 3
- Pages
- 441-451
- ISSN
- 0272-6386 (ISSN-L)
- PMC
- PMC2866514
- OpenAlex
- W2096512601
- Cited by
- 423
- References
- 16
- Citations by year
- 2026: 10 · 2025: 34 · 2024: 32 · 2023: 45 · 2022: 34 · 2021: 35 · 2020: 33 · 2019: 40 · 2018: 32 · 2017: 23 · 2016: 20 · 2015: 19 · 2014: 13 · 2013: 16 · 2012: 17
- FWCI
- 7.55
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Kidney Diseases (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Institute of Diabetes and Digestive and Kidney Diseases (5U01DK06102, U01DK060990, 5U01 DK60980, T32DK007785, T32DK060455, K01DK064860, U01DK060984, U01DK060902, U01DK060980, U01DK060963, U01DK061021, U01DK061028)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Keywords
- hypertension, chronic kidney disease, blood pressure control, hypertension awareness, antihypertensive medication use, ACE inhibitors, angiotensin receptor blockers, urinary albumin excretion, Chronic Renal Insufficiency Cohort Study, older adults, racial disparities
- MeSH terms
- Adult, Aged, Chronic Disease, Female, Humans, Hypertension, Kidney Diseases, Male, Middle Aged, Renal Insufficiency, Young Adult
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