Race and Sex Differences in Hypertension Control in CKD: Results From the Kidney Early Evaluation Program (KEEP)

Received 2 June 2007; accepted 24 September 2007. published online 03 January 2008.

Background

African American men with chronic kidney disease (CKD) progress to end-stage renal disease more rapidly than African American women or whites. Uncontrolled hypertension worsens CKD, and disparities in hypertension control may contribute to disparities in CKD progression.

Study Design

Cross-sectional.

Setting & Participants

10,827 individuals with CKD and self-reported hypertension screened in the Kidney Early Evaluation Program.

Predictors

African American race, sex.

Outcomes

Hypertension control (blood pressure <130 mm Hg systolic and/or <80 mm Hg diastolic).

Measurements

Self-report, physical examination (blood pressure), laboratory data (serum creatinine, microalbuminuria by urine dipstick). We calculated estimated glomerular filtration rates by using the 4-variable isotope dilution mass spectrometry Modification of Diet in Renal Disease Study equation. We classified CKD as early (stages 1 to 2) or late (stages 3 to 5) based on estimated glomerular filtration rate and microalbuminuria.

Results

In individuals with early CKD, African American women (odds ratio [OR], 1.47; 95% confidence interval [CI], 1.14 to 1.88), white men (OR, 1.85; 95% CI, 1.39 to 2.46), and white women (OR, 1.69; 95% CI, 1.28 to 2.22) had greater odds of hypertension control (blood pressure <130/80 mm Hg) than African American men. In individuals with late CKD, white men (OR, 1.66; 95% CI, 1.10 to 2.52) and white women (OR, 1.67; 95% CI, 1.13 to 2.46) had greater odds of hypertension control than African American men. No differences were seen between African American men and women with late CKD.

Limitations

No information for medication regimens.

Conclusions

African American men with CKD have poorly controlled hypertension compared with African American women and whites, particularly in the early stages of disease. Efforts to aggressively treat hypertension in this population may help narrow the race and sex disparities in progression to end-stage renal disease.

Index Words: Hypertension, chronic kidney disease, ethnic groups, sex

1 Division of General Internal Medicine/Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA

2 Division of Nephrology, Department of Medicine, USRDS Coordinating Center, Minneapolis, MN

3 Center for Outcomes Research, Christiana Care Health System, Newark, DE

4 Divisions of Preventive Medicine, Hypertension, and Nephrology, Department of Medicine, Pritzker School of Medicine, University of Chicago, Chicago

5 Department of Medicine, Jesse Brown Veterans Affairs Medical Center, Chicago, IL

6 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

7 Divisions of Cardiology, Nutrition, and Preventive Medicine, Department of Medicine, William Beaumont Hospital, Royal Oak, MI

8 Division of Endocrinology, Department of Medicine, Washington University School of Medicine, St Louis, MO

9 National Kidney Disease Education Program, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD

10 Division of Nephrology, Department of Medicine, The University of Texas Health Science Center, San Antonio, TX

11 Division of Nephrology, Department of Medicine, Brigham and Women’s Hospital, Boston, MA

12 Department of Medicine, Charles R. Drew University of Medicine and Science, Lynwood, CA.

Address correspondence to Obidiugwu Kenrik Duru, MD, Assistant Professor, Division of General Internal Medicine/Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095.

Originally published online as doi:10.1053/j.ajkd.2007.09.023 on December 28, 2007.

PII: S0272-6386(07)01447-3

doi:10.1053/j.ajkd.2007.09.023

13 of 33