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Indicator Details: ACE/ARB Use Among U.S. Adults with Hypertension and Severe Albuminuria
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  • NHANES

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In 2013-2018, ACEi/ARB use among adults with hypertension and albuminuria ≥300 mg/g was 47.5% (95% CI; 41.2%-53.8%). Among those with diabetes, ACEi/ARB use was 55.3% (95% CI; 47.0%-63.7%); among those without diabetes, ACEi/ARB use was 33.6% (95% CI; 22.5%-44.7%).

No consistent trends were observed for the proportion receiving ACEi/ARB treatment from 2001-2018 among persons with diabetes, without diabetes, or overall.

Chart Explanation: 

Among adults with hypertension and albuminuria ≥300 mg/g, ACEi/ARB use was 43.6% in 2001-2006, 53.1% in 2007-2012, and 47.5% in 2013-2018. Across all survey periods, no clear trends were observed between 2001-2006 and 2013-2018. Participants with diabetes were consistently more likely to be taking ACEi or ARB medications (56.6% in 2001-2006 to 55.3% in 2013-2018) compared to those without diabetes (32.0% in 2001-2006 to 33.6% in 2013-2018).

The National Health and Nutrition Examination Survey (NHANES) 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 2001-2002, 2003-2004, 2005-2006, 2007-2008, 2009-2010, 2011-2012, 2013-2014, and 2015-2016, and 2017-2018 NHANES.

Hypertension was defined by a mean systolic blood pressure ≥140 mmHg, mean diastolic blood pressure ≥90 mmHg, use of antihypertensive medication, or a “yes” answer to the question, “Have you ever been told by a doctor or other health professional that you had hypertension, also called high blood pressure?”. Angiotensin converting enzyme inhibitor (ACEi) or angiotensin II receptor blocker (ARB) use was ascertained by review of medication containers by NHANES study staff.

FieldData
Description of Measure

Use of angiotensin converting enzyme inhibitor or angiotensin II receptor blocker medications among adults with hypertension and albuminuria

Data Source

NCHS

Type of Data Source

Public

Data Set

NHANES

Health Care System Data

No

Regional or National?

National

Demographic Group

Noninstitutionalized U.S. residents aged 20+ years

Numerator

Participants taking either ACEi or ARB medications

Denominator

Participants with hypertension and urine albuminuria/creatinine ratio ≥300 mg/g

Hypertension

Defined as mean systolic blood pressure ≥140 mmHg, mean diastolic blood pressure ≥90 mmHg, use of antihypertensive medication, or a “yes” answer to the question, “Have you ever been told by a doctor or other health professional that you had hypertension, also called high blood pressure?”

ACEi or ARB medications

Angiotensin converting enzyme inhibitors: captopril, enalapril, fosinopril, quinapril, ramipril, benazepril, lisinopril, benazepril/hydrochlorothiazide, hydrochlorothiazide/lisinopril, captopril/hydrochlorothiazide, enalapril/hydrochlorothiazide, amlodipine/benazepril, moexipril, trandolapril, trandolapril/verapamil, hydrochlorothiazide/moexipril, perindopril, hydrochlorothiazide/quinapril, fosinopril/hydrochlorothiazide, amlodipine/perindopril, cilazapril

Angiotensin II receptor blockers: losartan, hydrochlorothiazide/losartan, valsartan, irbesartan, hydrochlorothiazide/irbesartan, eprosartan, hydrochlorothiazide/valsartan, candesartan, telmisartan, candesartan/hydrochlorothiazide, hydrochlorothiazide/telmisartan, olmesartan, eprosartan/hydrochlorothiazide, hydrochlorothiazide/olmesartan, amlodipine/valsartan, amlodipine/olmesartan, amlodipine/telmisartan, azilsartan, azilsartan/chlorthalidone

Primary Data Source Indicator

bpq020: “Have you ever been told by a doctor or other health professional that you had hypertension, also called high blood pressure?” yes/no

Primary Indicator Method of Measurement

Questionnaire (interviewer-administered)

Secondary (1) Variable

bpxsy1-4: systolic blood pressure

Secondary (1) Indicator Method of Measurement

Examination/Laboratory

Secondary (2) Variable

dpxdi1-4: diastolic blood pressure

Secondary (2) Indicator Method of Measurement

Examination/Laboratory

Secondary (3) Data Source Indicator

urxuma: Urine albumin

Secondary (3) Indicator Method of Measurement

Examination/Laboratory

Secondary (4) Data Source Indicator

urxucr: Urine creatinine

Secondary (4) Indicator Method of Measurement

Examination/Laboratory

Frequency of Measurement (Primary)

Once (cross-sectional)

U.S. Region Covered by Primary Variable

All

Period Currently Available

2001–2018

Pending Data
Limitations of Indicator

Albuminuria can only be assessed from a one-time cross-sectional measurement

Analytical Considerations

Appropriate NHANES survey weights must be used for all analyses; creatinine measurements must be calibrated for NHANES years 1999-2000 and 2005-2006; if 2007-2008 data are combined with 1999-2006 data, the earlier data on urinary creatinine must be corrected; many variable names differ across surveys; if SE 30% or more of estimate, must suppress estimates and 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