To improve cardiovascular care in people with CKD, Healthy People 2020 objective 6a aims to reduce the proportion of persons with CKD who have elevated blood pressure by 10%. The overall proportion of people with CKD and hypertension declined from 54.7% to 50.5% over the past decade, which is near the HP 2020 target of 49.3% or less.
Chart Explanation: While improvements have been observed for most age groups, the prevalence of hypertension has not improved appreciably for people older than 85 years or between 25-44 years of age. Hypertension prevalence has declined across all income categories; households with income below the federal poverty level declined by 5.7% of the baseline value, and those between 100-200% of poverty declined by 15.0% of baseline, surpassing the HP 2020 target of 10%. Hypertension prevalence among whites and Hispanics with CKD declined, however, an increase occurred among African Americans - with 71.9% having hypertension currently, compared with 66.2% at baseline.
The NHANES (National Health and Nutrition Examination Survey) is a nationally representative, cross-sectional survey that is currently conducted every 2 years by the National Center for Health Statistics to examine disease prevalence and trends over time in non-institutionalized U.S. civilian residents.
The NHANES is currently conducted every 2 years by the National Center for Health Statistics to examine disease prevalence and trends over time in different cross-sectional representative samples of non-institutionalized 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, and 2009-2010 NHANES, in addition to data from NHANES III (1988-1994). 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 1999-2000 and 2005-2006 participants; no correction was required for calibrated serum creatinine in participants in the 2001-2002, 2003-2004, 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. For comparisons across the 12-year period 1999-2010, albuminuria was corrected in 1999-2006 to account for differences in the instrumentation and method for urine creatinine starting in 2007. Prevalence of CKD is likely overestimated due to single measurements of albuminuria and kidney function, since chronic disease is defined as having albuminuria ror reduced kidney function for ≥3 months.
| Field | Data |
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| Description of Measure | Percent of persons with chronic kidney disease who have hypertension |
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| Data Source | |
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| Data Source | NCHS |
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| Type of Data Source | Public |
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| Data Set | NHANES |
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| Health Care System Data | No |
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| Regional or National? | National |
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| Demographic Group | Non-institutionalized adults 18+ years with CKD. |
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| Numerator | Number of adults aged 18 years and older with chronic kidney disease (CKD) stages 1-4 who also have self-reported hypertension, reported prescription for hypertension medication, or measured high systolic (≥140 mmHg) or diastolic (≥90 mmHg) pressure. |
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| Denominator | Number with CKD stages 1-4 who have blood pressure measurements. |
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| Definition of CKD | Stage 1, eGFR ≥ 90 ml/min/1.73 m² and estimated persistent albuminuria; Stage 2, 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 |
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| Definitions | Educational attainment data was collected only for subjects 25 years and over; health insurance status is limited to individuals under 65 years of age in order to exclude potential Medicare patients; family income was calculated as a percent of the Federal Poverty Limit. |
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| Glomerular filtration rate | Estimated 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) |
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| Proteinuria | Urinary albumin-to-creatinine ratios of 30-299 mg/g (microalbuminuria) and >300 mg/g (macroalbuminuria); pregnant/menstruating women excluded |
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| Primary Data Source Indicator | lbxscr: Serum creatinine |
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| Primary Indicator Method of Measurement | Examination/Laboratory |
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| Secondary (1) Variable | ridageyr: Age in years |
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| Secondary (1) Indicator Method of Measurement | Questionnaire (interviewer-administered) |
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| Secondary (2) Variable | ridgendr: Gender |
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| Secondary (2) Indicator Method of Measurement | Questionnaire (interviewer-administered) |
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| Secondary (3) Variable | No |
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| Secondary (3) Indicator Method of Measurement | ridreth1: Race/ethnicity |
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| Secondary (3) from Medical Record? | Questionnaire (interviewer-administered) |
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| Secondary (4) Data Source Indicator | urxuma: Urine albumin |
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| Secondary (4) Indicator Method of Measurement | Examination/lab |
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| Secondary (5) Data Source Indicator | urxucr: Urine creatinine |
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| Secondary (5) Indicator Method of Measurement | Examination/lab |
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| Frequency of Measurement (Primary) | Once (cross-sectional) |
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| U.S. Region Covered by Primary Variable | All |
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| Period Currently Available | 1999–2010 |
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| Pending Data | 2011-2016 |
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| Additional Data Items of Interest | Stage of CKD, year, other stratification variables of interest (diabetes by self-report, diabetes by glycohemoglobin and medicine use) |
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| Limitations of Indicator | Albuminuria 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 |
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| Analytic Considerations | Appropriate 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” |
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