CDC Surveillance System: Hypertension Among U.S. Adults with CKD, 1999-2004 vs. 2005-2010 vs. 2020 Target

Prevalence of Elevated Blood Pressure in CKD People 1999–2004 vs. 2005–2010 vs. 2020 Target^a,b,c by Educational Attainment (25 years and over) and Year National Health and Nutrition Examination Survey
Year	< High School	High School	Some college/ Associates degree	4 year college degree or more
1999–2004	63.5% (CI 55.2-71.7)	56.8% (CI 48.9-64.8)	66.8% (CI 59.4-74.1)	43.0% (CI 36.3-49.6)
2005–2010	58.2% (CI 49.9-66.4)	56.5% (CI 46.3-66.6)	52.0% (CI 41.8-62.2)	48.6% (CI 40.3-56.9)
2011–2016	59.9% (CI 50.4-68.9)	55.5% (CI 46.4-65.1)	51.9% (CI 42.9-61.9)	48.3% (CI 40.9-56.0)

Footnotes:
^a Family income was calculated as a percentage of the Federal Poverty Limit.

^b Educational attainment data was collected only for subjects 25 years and over.

^c Health Insurance Status was limited to individuals under 65 years of age in order to exclude potential Medicare patients.

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% (1999-2004 period) to 50.5% (2005-2010) and remained similar (50%) for the 2011-2016 period, though approaching to 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 3.1% of the baseline value, and those between 100-200% of poverty declined by 8.9% of baseline. Hypertension prevalence among African Americans with CKD increased- with 74.3% having hypertension currently, compared with 66.2% at baseline. Individuals with a 4-year degree or more experienced an increase in hypertension prevalence from 42.9% at baseline to 48.3% currently.

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 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 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, 2013-2014, and 2015-2016 NHANES. eGFR was calculated according to the modified study formula for calibrated creatinine (et al., 2005; 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 (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 or reduced kidney function for ≥3 months.

Field	Data
Description of Measure	Percent of persons with chronic kidney disease who have hypertension
Data Source
Data Source	NCHS
Type of Data Source	Public
Data Set	NHANES
Health Care System Data	No
Regional or National?	National
Demographic Group	Non-institutionalized adults 18+ years with CKD.
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.
Denominator	Number with CKD stages 1-4 who have blood pressure measurements.
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
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.
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)
Proteinuria	Urinary albumin-to-creatinine ratios of 30-299 mg/g (microalbuminuria) and >300 mg/g (macroalbuminuria); pregnant/menstruating women excluded
Primary Data Source Indicator	lbxscr: Serum creatinine
Primary Indicator Method of Measurement	Examination/Laboratory
Secondary (1) Variable	ridageyr: Age in years
Secondary (1) Indicator Method of Measurement	Questionnaire (interviewer-administered)
Secondary (2) Variable	ridgendr: Gender
Secondary (2) Indicator Method of Measurement	Questionnaire (interviewer-administered)
Secondary (3) Variable	No
Secondary (3) Indicator Method of Measurement	ridreth1: Race/ethnicity
Secondary (3) from Medical Record?	Questionnaire (interviewer-administered)
Secondary (4) Data Source Indicator	urxuma: Urine albumin
Secondary (4) Indicator Method of Measurement	Examination/lab
Secondary (5) Data Source Indicator	urxucr: Urine creatinine
Secondary (5) Indicator Method of Measurement	Examination/lab
Frequency of Measurement (Primary)	Once (cross-sectional)
U.S. Region Covered by Primary Variable	All
Period Currently Available	1999–2010
Pending Data	2011-2016
Additional Data Items of Interest	Stage of CKD, year, other stratification variables of interest (diabetes by self-report, diabetes by glycohemoglobin and medicine use)
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
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”

Suggested Citation:

Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States.
website. http://www.cdc.gov/ckd