title: Hypertension control and antihypertensive therapy in patients with chronic kidney disease.
abstract: BACKGROUND
  Hypertension is a major risk factor in the progression of chronic kidney disease (CKD). Although hypertension is more prevalent and treated more often among CKD patients, it is less likely to be controlled. Current guidelines recommend the use of multiple antihypertensive agents to achieve optimal blood pressure (BP) control. However, BP control attained by number and type of antihypertensive therapy according to CKD stage has not been examined thoroughly.
  
  
  METHODS
  Cross-sectional analysis of an electronic medical record (EMR) database.
  
  
  METHODS
  A total of 115,608 patients with CKD (Stages 1-4) and diagnosed or treated hypertension in General Electric Centricity EMR from 1996 to 2012.
  
  
  RESULTS
  BP control, based on JNC 7 guidelines, was defined as less than 130/80 mm Hg.
  
  
  METHODS
  BP and antihypertensive therapy use was obtained from the EMR. The Cockcroft-Gault equation was used to calculate estimated glomerular filtration rate and classify CKD stage.
  
  
  RESULTS
  Overall prevalence of BP control was 24.3%. BP control varied by CKD stage and number of antihypertensive therapy. In multivariable analysis, younger age was less likely to be associated with BP control, regardless of CKD stage. Multiple antihypertensive therapy use and BP control was strongest among CKD Stage 2 (odds ratio (OR): 1.41; 95% confidence interval (CI): 1.05, 1.90). Diuretic use was less likely to be associated with BP control among CKD Stage 1 (OR: 0.71; 95% CI: 0.59, 0.87) and 2 (OR: 0.78; 95% CI: 0.72, 0.85).
  
  
  CONCLUSIONS
  Information on antihypertensive prescription fill data and adherence to medication regimens was unavailable.
  
  
  CONCLUSIONS
  This study highlighted the need to pay closer attention to achieving BP treatment goals for younger individuals with CKD. More research is needed to assess the extent to which specific combinations of antihypertensive drugs leads to adequate BP control.
authors.affiliation: Pharmacotherapy Outcomes Research Center, Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA; sudhir.unni@pharm.utah.edu.
authors.forename: Sudhir
authors.initials: S
authors.lastname: Unni
authors.affiliation: Arnold School of Public Health, Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA;
authors.forename: Kellee
authors.initials: K
authors.lastname: White
authors.affiliation: Pharmacotherapy Outcomes Research Center, Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA;
authors.forename: Michael
authors.initials: M
authors.lastname: Goodman
authors.affiliation: Pharmacotherapy Outcomes Research Center, Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA;
authors.forename: Xiangyang
authors.initials: X
authors.lastname: Ye
authors.affiliation: Merck & Co., Inc., Whitehouse Station, New Jersey, USA.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Mavros
authors.affiliation: Merck & Co., Inc., Whitehouse Station, New Jersey, USA.
authors.forename: Lori D
authors.initials: LD
authors.lastname: Bash
authors.affiliation: Pharmacotherapy Outcomes Research Center, Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA;
authors.forename: Diana
authors.initials: D
authors.lastname: Brixner
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D001795:Blood Pressure Determination / Q000379:methods; D003430:Cross-Sectional Studies; D018450:Disease Progression; D057286:Electronic Health Records; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000959:Antihypertensive Agents
keywords: antihypertensive therapy; blood pressure control; chronic kidney disease; electronic medical record; hypertension.