TY - JOUR
T1 - Angiotensin-Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Use Among Hypertensive US Adults With Albuminuria
AU - The Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team
AU - Chu, Chi D.
AU - Powe, Neil R.
AU - McCulloch, Charles E.
AU - Banerjee, Tanushree
AU - Crews, Deidra C.
AU - Saran, Rajiv
AU - Bragg-Gresham, Jennifer
AU - Morgenstern, Hal
AU - Pavkov, Meda E.
AU - Saydah, Sharon H.
AU - Tuot, Delphine S.
N1 - Funding Information:
C.D. Chu was supported by the National Institute Of Diabetes And Digestive And Kidney Diseases (NIDDK) of the National Institutes of Health under Award F32DK122629. The NIDDK had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the article; and decision to submit the article for publication. Research reported in this publication is solely the responsibility of the authors and does not necessarily represent the official views or positions of the National Institutes of Health or the Centers for Disease Control and Prevention.
Publisher Copyright:
© 2020 American Heart Association, Inc.
PY - 2021/1/1
Y1 - 2021/1/1
N2 - Since 2003, US hypertension guidelines have recommended ACE (angiotensin-converting enzyme) inhibitors or ARBs (angiotensin receptor blockers) as first-line antihypertensive therapy in the presence of albuminuria (urine albumin/creatinine ratio ≥300 mg/g). To examine national trends in guideline-concordant ACE inhibitor/ARB utilization, we studied adults participating in the National Health and Nutrition Examination Surveys 2001 to 2018 with hypertension (defined by self-report of high blood pressure, systolic blood pressure ≥140 mm Hg or diastolic ≥90 mm Hg, or use of antihypertensive medications). Among 20 538 included adults, the prevalence of albuminuria ≥300 mg/g was 2.8% in 2001 to 2006, 2.8% in 2007 to 2012, and 3.2% in 2013 to 2018. Among those with albuminuria ≥300 mg/g, no consistent trends were observed for the proportion receiving ACE inhibitor/ARB treatment from 2001 to 2018 among persons with diabetes, without diabetes, or overall. In 2013 to 2018, ACE inhibitor/ARB usage in the setting of albuminuria ≥300 mg/g was 55.3% (95% CI, 46.8%-63.6%) among adults with diabetes and 33.4% (95% CI, 23.1%-45.5%) among those without diabetes. Based on US population counts, these estimates represent 1.6 million adults with albuminuria ≥300 mg/g currently not receiving ACE inhibitor/ARB therapy, nearly half of whom do not have diabetes. ACE inhibitor/ARB underutilization represents a significant gap in preventive care delivery for adults with hypertension and albuminuria that has not substantially changed over time.
AB - Since 2003, US hypertension guidelines have recommended ACE (angiotensin-converting enzyme) inhibitors or ARBs (angiotensin receptor blockers) as first-line antihypertensive therapy in the presence of albuminuria (urine albumin/creatinine ratio ≥300 mg/g). To examine national trends in guideline-concordant ACE inhibitor/ARB utilization, we studied adults participating in the National Health and Nutrition Examination Surveys 2001 to 2018 with hypertension (defined by self-report of high blood pressure, systolic blood pressure ≥140 mm Hg or diastolic ≥90 mm Hg, or use of antihypertensive medications). Among 20 538 included adults, the prevalence of albuminuria ≥300 mg/g was 2.8% in 2001 to 2006, 2.8% in 2007 to 2012, and 3.2% in 2013 to 2018. Among those with albuminuria ≥300 mg/g, no consistent trends were observed for the proportion receiving ACE inhibitor/ARB treatment from 2001 to 2018 among persons with diabetes, without diabetes, or overall. In 2013 to 2018, ACE inhibitor/ARB usage in the setting of albuminuria ≥300 mg/g was 55.3% (95% CI, 46.8%-63.6%) among adults with diabetes and 33.4% (95% CI, 23.1%-45.5%) among those without diabetes. Based on US population counts, these estimates represent 1.6 million adults with albuminuria ≥300 mg/g currently not receiving ACE inhibitor/ARB therapy, nearly half of whom do not have diabetes. ACE inhibitor/ARB underutilization represents a significant gap in preventive care delivery for adults with hypertension and albuminuria that has not substantially changed over time.
KW - albuminuria
KW - angiotensin receptor antagonists
KW - angiotensin-converting enzyme inhibitors
KW - blood pressure
KW - guideline adherence
UR - http://www.scopus.com/inward/record.url?scp=85097968010&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85097968010&partnerID=8YFLogxK
U2 - 10.1161/HYPERTENSIONAHA.120.16281
DO - 10.1161/HYPERTENSIONAHA.120.16281
M3 - Article
C2 - 33190561
AN - SCOPUS:85097968010
SN - 0194-911X
VL - 77
SP - 94
EP - 102
JO - Hypertension
JF - Hypertension
IS - 1
ER -