Time to Initiation of Antihypertensive Therapy After Onset of Elevated Blood Pressure in Patients With Primary Proteinuric Kidney Disease

• Main Authors: Donald J. Weaver, Jr., Anne Waldo, Gia J. Oh, Elaine S. Kamil, Matthew Elliott, Sharon Adler, Anne Pesenson, Meg M. Modes, Patrick Gipson, Richard A. Lafayette, David T. Selewski, Samara E. Attalla, Richard Eikstadt, Jonathan P. Troost, Debbie S. Gipson, Susan F. Massengill
• Format: Article
• Language: English
• Published: Elsevier 2020-03-01
• Series: Kidney Medicine
• Online Access: http://www.sciencedirect.com/science/article/pii/S2590059520300017

Rationale & Objective: The objective of the study was to estimate the prevalence of hypertension in patients with proteinuric kidney disease and evaluate blood pressure (BP) control. Study Design: Retrospective cohort study. Setting & Participants: Data from adults and children with proteinuric kidney disease enrolled in the multicenter Kidney Research Network Registry were used for this study. Exposure: Proteinuric kidney disease. Outcomes: Hypertension and BP control. Analytical Approach: Patients with white-coat hypertension were excluded. Patients were censored at end-stage kidney disease onset. Patients were defined as hypertensive either by hypertension diagnosis code, having 2 or more encounters with elevated BPs, or treatment with antihypertensive therapy excluding renin-angiotensin-aldosterone system blockade. Elevated BP was defined as greater than 95th percentile for children and >140/90 mm Hg in adults. Sustained BP control was defined as 2 or more consecutive encounters with BPs lower than 95th percentile for children and <140/90 mm Hg for adults. Kaplan-Meier and Cox proportional hazards analyses were used to evaluate the time to initiation of antihypertensive therapy. Results: 842 patients, 69% adults and 31% children, with a total observation period of 6,722 patient-years were included in the analysis. 644 (76%) had hypertension during observation. There was no difference in the prevalence of hypertension between children and adults (74% vs 78%; P = 0.3). Hypertension was most common among those of African American race compared with other races (90% vs 72%-75%; P = 0.003). 504 (78%) patients with hypertension achieved BP control but only 51% achieved control within 1 year. 140 (22%) patients with hypertension never achieved BP control during a median of 41 (IQR, 24-73) months of observation. Limitations: Differing BP control goals that may lead to overestimation of the controlled patient population. Conclusions: Hypertension affects most patients with proteinuric kidney disease regardless of age. Time to BP control exceeded 1 year in 50% of patients with hypertension and 22% did not demonstrate control. This study highlights the need to address hypertension early and completely in disease management of patients with proteinuric kidney disease. Index Words: Chronic kidney disease, elevated blood pressure, hypertension, proteinuria