Angiotensin-Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Use among Hypertensive US Adults with Albuminuria

Chi D. Chu, Neil R. Powe, Charles E. McCulloch, Tanushree Banerjee, Deidra C. Crews, Rajiv Saran, Jennifer Bragg-Gresham, Hal Morgenstern, Meda E. Pavkov, Sharon H. Saydah, Delphine S. Tuot

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish (US)
Pages (from-to)94-102
Number of pages9
StateAccepted/In press - 2020
Externally publishedYes


  • albuminuria
  • angiotensin receptor antagonists
  • angiotensin-converting enzyme inhibitors
  • blood pressure
  • guideline adherence

ASJC Scopus subject areas

  • Internal Medicine


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