Glomerular Diseases
Blood pressure control in the Kidney Research Network before and after the 2017 guideline change
By Donald J. Weaver, Nathaniel Putnam, Sharon G. Adler and 6 others.
Abstract
Background
The association between hypertension and accelerated deterioration in kidney function is well-established, yet inadequate blood pressure control persists in patients with chronic kidney disease. We investigated if the updated guidelines for hypertension management led to improved blood pressure control in patients after 2017 compared to pre-2017.
Methods
Data were used from the Kidney Research Network electronic health record registry. Hypertension was defined using blood pressure measurements, ICD-9/10 codes, and medication records. Follow-up was split into two eras, pre-2017 and post-2017, however post-2017 guidelines on hypertension were applied to both eras. Blood pressure control was defined as observing healthy blood pressure for 75% of follow-up after hypertension diagnosis. We used logistic regression with a logit link and an unstructured correlation matrix to evaluate the effect of era on blood pressure control, adjusting for sex, race, glomerular disease diagnosis, medication usage, pre-diagnosis blood pressure, kidney function, proteinuria, and weight. Sequential regression was used to determine which variables were mediating the effect of era on blood pressure control.
