Li Fanghua, Sun Anbang, Wu Feng, Zhang Dongshan, Zhao Zhanzheng
Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Department of Anatomy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Cardiovasc Med. 2023 Feb 9;10:990997. doi: 10.3389/fcvm.2023.990997. eCollection 2023.
Blood pressure (BP) control rates among adult patients taking antihypertensive medications in the United States have not improved over the last decade. Many CKD adults require more than one class of antihypertensive agent to reach the BP target recommended by the guidelines. However, no study has quantified the proportion of adult CKD patients taking antihypertensive medication who are on monotherapy or combination therapy.
National Health and Nutrition Examination Survey data during 2001-2018 was used, including adults with CKD taking antihypertensive medication (age ≥ 20 years, = 4,453). BP control rates were investigated under the BP targets recommended by the 2021 KDIGO, the 2012 KDIGO, and the 2017 ACC/AHA guidelines.
The percentages of uncontrolled BP among US adults with CKD taking antihypertensive medication were 81.4% in 2001-2006 and 78.2% in 2013-2018. The proportion of monotherapy of antihypertensive regimen were 38.6, 33.3, and 34.6% from 2001 to 2006, 2007-2012, and 2013-2018, with no obvious difference. Similarly, there was no significant change in percentages of dual-therapy, triple-therapy, and quadruple-therapy. Although proportion of CKD adults not treated with ACEi/ARB decreased from 43.5% in 2001-2006 to 32.7% in 2013-2018, treatment of ACEi/ARB among patients with ACR > 300 mg/g had no significant change.
The BP control rates among US adult CKD patients taking antihypertensive medications have not improved from 2001 to 2018. Mono-therapy accounted for about one third of adult CKD patients taking antihypertensive medication and not changed. Increasing antihypertensive medication combination therapy may help improve BP control in CKD adults in the United States.
在过去十年中，美国服用抗高血压药物的成年患者的血压控制率并未提高。许多慢性肾脏病（CKD）成人患者需要不止一类抗高血压药物才能达到指南推荐的血压目标。然而，尚无研究对服用抗高血压药物的成年CKD患者接受单药治疗或联合治疗的比例进行量化。
使用2001 - 2018年期间的美国国家健康与营养检查调查数据，包括服用抗高血压药物的CKD成人（年龄≥20岁，n = 4453）。根据2021年改善全球肾脏病预后组织（KDIGO）、2012年KDIGO以及2017年美国心脏病学会/美国心脏协会（ACC/AHA）指南推荐的血压目标来调查血压控制率。
2001 - 2006年期间，美国服用抗高血压药物的CKD成年患者中血压未得到控制的比例为81.4%，2013 - 2018年为78.2%。2001年至2006年、2007 - 2012年以及2013 - 2018年抗高血压治疗方案的单药治疗比例分别为38.6%、33.3%和34.6%，无明显差异。同样，双联治疗、三联治疗和四联治疗的比例也无显著变化。尽管未接受血管紧张素转换酶抑制剂（ACEi）/血管紧张素Ⅱ受体阻滞剂（ARB）治疗的CKD成人比例从2001 - 2006年的43.5%降至2013 - 2018年的32.7%，但在尿白蛋白肌酐比值（ACR）> 300 mg/g的患者中，ACEi/ARB的治疗情况无显著变化。
2001年至2018年期间，美国服用抗高血压药物的成年CKD患者的血压控制率并未改善。单药治疗约占服用抗高血压药物的成年CKD患者的三分之一且无变化。增加抗高血压药物联合治疗可能有助于改善美国CKD成人患者的血压控制。
