Hypertension and CVD risk factor management in multi-ethnic adults with CKD - a cross sectional study in general practice

Abstract Background: Hypertension (HT), especially if poorly controlled, is a key determinant of CKD development and progression to end stage renal disease (ESRD). Aim: To assess hypertension and risk factor management, and determinants of SBP control in individuals with CKD and HT. Design and setting: Cross-sectional survey using primary care electronic health records (EHRs) from 47/49 GP clinics in South London. Method: Known effective interventions, management of hypertension and CVD risk in patients with CKD Stages 3-5 was investigated. Multivariable logistic regression analysis examined the association of demographic factors, comorbidities, deprivation, and CKD coding, with systolic blood pressure (SBP) control status as outcome. Individuals with diabetes were excluded. Results: Adults with CKD Stages 3-5 and HT represented 4,131/286,162 (1.4%) of the total population; 1,984 (48%) of these individuals had undiagnosed CKD without a recorded CKD clinical code. Hypertension was undiagnosed in 25% of the total Lambeth population, and in patients with CKD without diagnosed HT, 23.0% had SBP >140mmHg compared with 39.8% hypertensives, p<0.001. Multivariable logistic regression revealed factors associated with improved SBP control in CKD were diastolic blood pressure (DBP) control, serious mental illness, history of cardiovascular co-morbidities, CKD diagnostic coding, and age <60 years. African ethnicity and obesity were associated with poorer SBP control. Conclusion: We found both underdiagnosed CKD and underdiagnosed hypertension in those with CKD. The poorer SBP control in older age groups ≥60 years and in Black African or obese individuals is clinically important as these groups are at increased risk of increased CVD mortality.