While 98% of adult cohort study enrollees with CKD reported using antihypertensive medications, only 67% had controlled blood pressure (<140/90 mmHg); using more recent CKD-specific guidelines for control (<130/80), the percentage controlled was only 46%.
Chart Explanation: Overall, nearly all (98%) CRIC participants with hypertension reported being treated with antihypertensive medications. Despite this, only 67% were controlled by general JNC-VI guidelines (<140/90 mmHg; Chobanian et al., 2003). Using the more stringent CKD-specific guidelines for control recommended in this report (<130/80 mmHg), only 46% were controlled.
The Chronic Renal Insufficiency Cohort (CRIC) study is a cohort study of 3,612 individuals 21-74 years of age with CKD of varying severity, recruited from 13 sites across the United States in 2003-2007. CRIC was designed to study consequences of CKD with a particular focus on cardiovascular illness like myocardial infarction (heart attack) and stroke. As with all cohort studies, participants may not be representative of all those who live in the communities from which they are recruited.
Analyses for this measure were performed in 3,612 adults with CKD enrolled in the Chronic Renal Insufficiency Cohort (CRIC) study. Baseline blood pressure and self-reported use of antihypertensive medications were used to define treatment and control. Complete methods can be found in Muntner et al. (2010).
|Description of Measure||Blood pressure treatment and control among adults with CKD|
|Data Source||CRIC prospective observational cohort study|
|Type of Data Source||Private|
|Data Set||CRIC summarized data|
|Health Care System Data||No|
|Regional or National?||National|
|Demographic Group||Adults (21-74 years old) with mild to severe CKD who are treated throughout 13 sites in 7 U.S. centers|
|Numerator||Enrolled adults reporting treatment or having controlled blood pressure|
|Denominator||Enrolled adults with hypertension measurements|
|Definition of CKD||Estimated GFR of 20-70 (ages 21-44); 20-60 (ages 45-64) and 20-50 (ages 65+) ml/min/1.73 m² (for entry into study)|
|Glomerular filtration rate||Estimated, MDRD Study equation|
|Primary Data Source Indicator||Blood pressure|
|Primary Indicator Method of Measurement||Average of 3 measurements in sitting position after 5 minutes of quiet rest according to standard protocol|
|Secondary (1) Variable||Antihypertensive treatment|
|Secondary (1) Indicator Method of Measurement||Self-report|
|Frequency of Measurement (Primary)||Once (baseline)|
|U.S. Region Covered by Primary Variable||Seven urban centers throughout the United States (Baltimore, MD; Philadelphia, PA; Cleveland, OH; Detroit, MI; Chicago, IL; New Orleans, LA; Oakland, CA)|
|Period Currently Available||2003–2007|
|Pending Data||None for baseline; further visits scheduled|
|Additional Data Items of Interest||Stage of CKD, stratification variables of interest (age, gender, race/ethnicity), diabetes, labs|
|Limitations of Indicator||Cross-sectional analyses and possibly “healthy cohort” effect|
|Analytical Considerations||Data summarized by CRIC investigators (see Muntner et al.); as with all cohort studies, selection bias and possible confounding|
References and Sources:
Muntner P, Anderson A, Charleston J, et al. Hypertension awareness, treatment, and control in adults with CKD: results from the Chronic Renal Insufficiency Cohort (CRIC) study. Am. J. Kidney Dis. 2010;55(3):441-451.