Hypertension and CKD: Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES), 1999-2004

Abstract

The prevalence and incidence of hypertension are increasing, and they correlate with the chronic kidney disease rate in the United States. Early identification and achievement of blood pressure goals may improve chronic kidney disease outcomes. In this cross-sectional study, subjects were participants in the Kidney Early Evaluation Program (KEEP), a voluntary community-based health-screening program enrolling individuals 18 years and older with diabetes, hypertension, or family history of kidney disease, diabetes, or hypertension, administered by the National Kidney Foundation; and the National Health and Nutrition Examination Survey (NHANES), administered by the National Center for Health Statistics. All studied individuals in both databases were US residents aged 18 years or older. We evaluated multiple variables for participants in KEEP 2000-2006 and participants in NHANES 1999-2004 in this logistic analysis. Although distributions of hypertension were similar between databases, KEEP participants with cardiovascular risk factors, especially current smoking, have a greater prevalence of hypertension than similar NHANES participants. Of hypertensive participants, 35.8% were African American in KEEP data, and 13.2% in NHANES data. Associations with increased prevalence of hypertension were decreasing estimated glomerular filtration rate by increments of 10 mL/min/1.73 m(2), increasing age, obesity, African American race, and microalbuminuria. In both KEEP and NHANES data, study group participants younger than 46 years were more likely to have achieved goal blood pressure. Several elements were identified by both registries as risk factors for linearly associated worsening of hypertension. In addition to the traditional risk factors of age, race, and geographic residence, such novel markers as microalbuminuria may also increase the risk.