Sun Anbang, Zhu Lin, Xia Yanmin, Zheng Yao, Hu Bicheng, Li Fanghua, Liao Yanhong
Department of Transfusion Medicine, Traditional Chinese and Western Medicine Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
Department of Anatomy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
Int J Med Sci. 2025 Jan 13;22(3):696-707. doi: 10.7150/ijms.103107. eCollection 2025.
Blood pressure (BP) control can slow down the progression of chronic kidney disease (CKD) and protect against cardiovascular diseases, significantly improving patient survival. Herein, we analyzed the changes in BP control in adult CKD patients with hypertension in the United States from 1999-2000 to 2017-2018. National Health and Nutrition Examination Survey (NHANES) data from 1999-2000 to 2017-2018 were analyzed, including 5,510 adult CKD patients with BP above 140/90 mmHg or those under an antihypertensive regimen. The proportion of adult CKD patients with uncontrolled BP decreased from 72.9% in 1999-2000 to 46.6% in 2013-2014, then increased to 56.9% in 2017-2018. Although adult CKD patients with albumin-creatinine rate (ACR) 30-299 mg/g or ACR ≥300 mg/g were more likely to take antihypertensive medication than those with ACR <30 mg/g (PR: 2.76, 95% CI: 1.63-4.79 and PR: 4.59, 95% CI: 2.37-9.51), they were more likely to have uncontrolled BP than those with ACR <30 mg/g ((multivariable-adjusted prevalence ratio (PR): 2.25, 95% CI: 1.39-3.75 and PR: 3.14, 95% CI: 1.71-6.07). Adult CKD patients (eGFR ≥60 mL/min/1.73m) being aware of their high BP diagnosis were less likely to take antihypertensive medication than those with eGFR 30-59 mL/min/1.73m (PR: 0.27, 95% CI: 0.09-0.65). These results show that BP control should be reinforced in adult CKD patients, particularly in those with ACR ≥300 mg/g, while patients with eGFR ≥60 mL/min/1.73m should enhance awareness of taking antihypertensive medication.
血压控制可减缓慢性肾脏病（CKD）的进展，并预防心血管疾病，显著提高患者生存率。在此，我们分析了1999 - 2000年至2017 - 2018年美国成年高血压CKD患者的血压控制变化情况。分析了1999 - 2000年至2017 - 2018年的国家健康和营养检查调查（NHANES）数据，其中包括5510名血压高于140/90 mmHg或正在接受降压治疗的成年CKD患者。血压未得到控制的成年CKD患者比例从1999 - 2000年的72.9%降至2013 - 2014年的46.6%，随后在2017 - 2018年又升至56.9%。尽管白蛋白 - 肌酐比值（ACR）为30 - 299 mg/g或ACR≥300 mg/g的成年CKD患者比ACR<30 mg/g的患者更有可能服用降压药物（PR：2.76，95%CI：1.63 - 4.79和PR：4.59，95%CI：2.37 - 9.51），但他们比ACR<30 mg/g的患者更有可能血压控制不佳（多变量调整患病率比值（PR）：2.25，95%CI：1.39 - 3.75和PR：3.14，95%CI：1.71 - 6.07）。估算肾小球滤过率（eGFR）≥60 mL/min/1.73m²的成年CKD患者知晓自己患有高血压诊断后服用降压药物的可能性低于eGFR为30 - 59 mL/min/1.73m²的患者（PR：0.27，95%CI：0.09 - 0.65）。这些结果表明，应加强成年CKD患者的血压控制，尤其是ACR≥300 mg/g的患者，而eGFR≥60 mL/min/1.73m²的患者应提高服用降压药物的意识。
