Indicator Details: Hypertension Prevalence in the CKD Populationa
Data Sources
 
Stratification and Year Choices:

  Source
  • NHANES

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Footnotes:
a Estimates are adjusted for age.


Related Are You Aware (AYA)


With adjustment for age, prevalence of hypertension by self-report or measured blood pressure ≥140/≥90 mmHg in the United States CKD population was 59.1% for the period 2013-2014. 
Chart Explanation: 
The NHANES (National Health and Nutrition Examination Survey) is a nationally representative, cross-sectional survey that is currently conducted every 2 years by the Centers for Disease Control and Prevention's National Center for Health Statistics to examine disease prevalence and trends over time in noninstitutionalized U.S. civilian residents.

The survey consists of a standardized in-home interview and a physical examination and blood and urine collection at a mobile examination center (MEC). Here we examined data from the 1999-2000, 2001-2002, 2003-2004, 2005-2006, 2007-2008, 2009-2010, 2011-2012, and 2013-2014 NHANES. CKD was diagnosed by laboratory testing and defined as an eGFR of ≥60 ml/min/1.73 m² and the presence of albuminuria (first single measurement of albumin:creatinine ratio from random spot urine) or by eGFR alone for CKD stage 3 or 4 (stage 5 was excluded).

Hypertension is the second leading cause of CKD. Hypertensive disease accounts for 28% of incident ESRD in the United States (U.S. Renal Data System, 2011). Hypertension is associated with higher risk of cardiovascular outcomes in those with CKD. Additionally, treatment of hypertension in CKD, particularly by ACE inhibitors, has been shown to decrease proteinuria and disease progression (Sarafidis et al., 2008). Thus, assessing the prevalence of this risk factor and its control is essential to CKD surveillance. Self-reported hypertension was defined by answer of “yes” to the question “Have you ever been told by a doctor or other health professional that you have hypertension, or high blood pressure?” Blood pressure measurements were taken by standardized protocol during the MEC and the average value (up to four measurements) was used. Hypertension medications were recorded from prescription bottles during the interview.
FieldData
Description of MeasurePrevalence of hypertension and blood pressure control in the adult CKD population; analysis is adjusted for age
Data SourceNCHS/CDC
Type of Data SourcePublic
Data SetNHANES
Health Care System DataNo
Regional or National?National
Demographic GroupNoninstitutionalized U.S. residents aged 20+ years
NumeratorParticipants with self-report, high (>140/90) blood pressure measurements, or hypertension drug use. 
DenominatorParticipants with CKD
Definition of CKDeGFR ≥ 90 ml/min/1.73 m² and estimated persistent albuminuria; eGFR 60-89 ml/min/1.73 m² and estimated persistent albuminuria; Stage 3, eGFR 30-59 ml/min/1.73 m²; Stage 4, 15-29 ml/min/1.73 m²; Stage 5, excluded
Glomerular filtration rateEstimated using MDRD Study equation for calibrated creatinine: eGFR=175 × [(calibrated serum creatinine in mg/dl)-1.154] × age-0.203 × (0.742 if female) × (1.210 if African-American)
ProteinuriaUrinary albumin-to-creatinine ratios of 30-299 mg/g (microalbuminuria) and >300 mg/g (macroalbuminuria); pregnant/menstruating women excluded
Primary Data Source Indicatorbpq020: “Have you ever been told by a doctor or health professional that you have high blood pressure?” yes/no
Primary Indicator Method of MeasurementQuestionnaire (interviewer-administered); ages 16+
Secondary (1) Variablebpxsy1-bpxsy4: Up to four blood pressure measurements
Secondary (1) Indicator Method of MeasurementExamination/Laboratory
Secondary (2) Variablenhcode/rxddrgid: generic drug codes
Secondary (2) Indicator Method of MeasuremenrQuestionnaire (interviewer-administered), with recording of medications from Rx bottles
Frequency of Measurement (Primary)Once (cross-sectional)
U.S. Region Covered by Primary VariableAll
Period Currently Available1999–2014
Pending Data2015-2016
Additional Data Items of InterestStage of CKD, stratification variables of interest (age, gender, race/ethnicity, BMI, hypertension by self-report)
Limitations of IndicatorAlbuminuria and kidney function can only be assessed from a one-time cross-sectional measurement, leading to overestimation of prevalence; second measures of albuminuria are available for only 2009-2010 and were first-morning rather than spot urine samples; no second measures of creatinine
Analytic ConsiderationsAppropriate NHANES survey weights must be used for all analyses; creatinine measurements must be calibrated for NHANES III, 1999-2000 and 2005-2006; many variable names differ across surveys; if SE 30% or more of estimate, must report as “low precision”
Suggested Citation:
Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States.
website. http://www.cdc.gov/ckd