Indicator Details: Proportion of Antihypertensive Drug Usea,b,c
Data Sources
 
Stratification and Year Choices:

  Source
  • NHANES

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  Chart Format


Published literature or one-time analysis, ongoing surveillance not available Published literature or one-time analysis, ongoing surveillance not available

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Footnotes:
a The difference in the proportion of use of ACE inhibitors according to stage of CKD has a p-value of 0.02.

b The difference in the proportion of use of diuretics according to stage of CKD has a p-value of 0.02.

c eGFR for this indicator was calculated using the isotope dilution mass spectrometry (IDMS)-traceable MDRD Study equation for calibrated creatinine. We are currently in the process of updating this indicator to instead use the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation.




β-blockers were the most common antihypertensive drug class used by participants with CKD. ACE inhibitors and ARBs accounted for only about one third of drug class use, despite the clinical guidelines that recommend these two drug classes over the others for treatment of hypertension. Angiotensin-converting enzyme (ACE) inhibitors and diuretics were the only two drug classes for which the proportion of use in the cohort differed significantly according to stage.

The proportion of antihypertensive drug use only differed significantly across the four stages of CKD for ACE inhibitors and diuretics. 
Chart Explanation: The proportion using five classes of antihypertensive drugs was compared across participants with CKD. Beta-blockers were the most common drug class used by participants with CKD, with 28.98% of the sample population reporting use. Diuretics were the second most common antihypertensive drug class used by the sample population (24.68% of the population reported use), followed by angiotensin-converting enzyme (ACE) inhibitors (23.8%), and calcium channel blockers (CCBs) (12.7%). Angiotensin receptor blockers (ARBs) were used the least frequently (only 9.83% of participants reported use). 

The proportion using five classes of antihypertensive drugs was also determined according to the four stages of CKD. Angiotensin-converting enzyme (ACE) inhibitors and diuretics were the only two drug classes for which the proportion of use differed significantly according to stage. Participants with Stage 3 CKD were much more likely to utilize an antihypertensive drug than participants at any other stage of CKD and accounted for over 45% of the utilization of the five drug classes examined. Within the examined cohort, the proportion of participants with stage I CKD (44.45%) was highest, followed by stage III (31.19%) and stage II (22.17%); it was lowest for stage IV (2.19%). 
The NHANES 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 different cross-sectional representative samples of 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). This study was a retrospective cross-sectional analysis of the NHANES surveys from 2005-2010. The study population comprises 116,231,361 NHANES participants aged 20 years and older with CKD. The investigators examined the antihypertensive medication use of the study population. eGFR was calculated according to the modified MDRD study formula for calibrated creatinine (Levey et al., 2005; Levey et al., 2006). Serum creatinine was calibrated for 2005-2006 participants; no correction was required for calibrated serum creatinine in participants in the 2007-2008 and 2009-2010 surveys (Selvin et al., 2007). Albuminuria was defined by urinary albumin-to-creatinine ratios of 30-299 mg/g (microalbuminuria) and >300 mg/g (macroalbuminuria); pregnant women were excluded.

This indicator is based upon analysis in published literature: Sonawane KB, Qian J, Hansen RA. Utilization patterns of antihypertensive drugs among the chronic kidney disease population in the United States: a cross-sectional analysis of the national health nutrition examination survey. Clin Ther. 2015;37(1):188-196.
http://www.ncbi.nlm.nih.gov/pubmed/25524390
FieldData
Description of MeasureProportion of antihypertensive drug use by drug class
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 or older
NumeratorUsers of a specific drug class among NHANES participants aged 20 years or older with CKD
Denominator
Users of antihypertensive medication among NHANES participants aged 20 years or older 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 formula 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) Schwartz formula for 12- to 17-year olds: eGFR=k × (height in cm) × (serum creatinine in mg/dl), where k=0.55 for 1- to 13-year olds and females aged 13-17 years; and k=0.65 for males aged 13-17 years.
ProteinuriaSpot urine albumin-to-creatininewas used from the laboratory data for assessment of kidney damage (417 mg/g for men or 425 mg/g for women indicates kidney damage at stages I and II), and this information was subsequently used to identify the early stages of CKD
Primary Data SourceUse of a specific antihypertensive medication drug class
Primary Indicator Method of MeasurementQuestionnaire component of NHANES; participants were asked if they had taken a medication in the past month for which a prescription was required and respondents who answered “yes” were asked to provide the drug container to obtain names of the drugs
Frequency of Measurement (Primary)Once (cross-sectional)
Period Current Available2005-2010
Pending DataNone
U.S. Region Covered by VariableAll
Additional Data Items of InterestAge, sex, race, self-reported hypertension, self-reported diabetes
Limitations of IndicatorData on use of antihypertensive medication might be inaccurate due to the data collection method used (i.e., interviews)
Analytical ConsiderationsAppropriate NHANES survey weights must be used for all analyses; creatinine measurements must be calibrated for 2005-2006; many variable names differ across surveys; if standard error (SE) 30% or more of estimate, must report as “low precision”
References and Sources:
  • Sonawane KB, Qian J, Hansen RA. Utilization patterns of antihypertensive drugs among the chronic kidney disease population in the United States: a cross-sectional analysis of the national health nutrition examination survey. Clin Ther. 2015;37(1):188-196.
    http://www.ncbi.nlm.nih.gov/pubmed/25524390
Suggested Citation:
Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States.
website. http://www.cdc.gov/ckd