On February 23, the Johns Hopkins Bloomberg School of Public Health (JHBS) published the research results recommendation for more intensive blood pressure management with in kidney disease could, if followed, benefit nearly 25 million Americans
In the study, the researchers analyzed blood pressure and other data on a sample of 1,699 U.S. adults with chronic kidney disease in the 2015-2018 National Health and Nutrition Examination Survey to gauge the proportion of chronic kidney disease patients who would potentially benefit from the new KDIGO guidelines.
The Survey
The analysis suggests that at the time of the 2015-18 National Health and Nutrition Examination Survey, 14.4 million U.S. adults with chronic kidney disease were not taking blood-pressure lowering medicines. Of these, 61.8 percent, or about 8.9 million U.S. adults, had systolic blood pressure levels over 120 mmHg and thus should consider starting on blood-pressure lowering medicines under the new guidelines.
The new recommendation from Kidney Disease: Improving Global Outcomes, a global nonprofit that develops evidence-based clinical practice guidelines in kidney disease, is aimed at doctors to help them to reduce blood pressure for chronic kidney disease patients whose systolic blood pressure levels are over 120 mmHg. Blood pressure can be reduced using antihypertensive medications and lifestyle modifications. The analysis indicates that 69.5 percent of chronic kidney disease patients in the United States—a total of 24.5 million people—would meet that criterion.
The study appears alongside the new Kidney Disease: Improving Global Outcomes (KDIGO) guidelines on February 18 in the journal Kidney International. “This is a major update of an influential set of guidelines for chronic kidney disease patients, and it is coming out against a backdrop of worsening blood pressure control in the U.S.,” says study first author Kathryn Foti, PhD, a postdoctoral researcher in the Department of Epidemiology at the Bloomberg School.
Research And Blood Pressure Management
Researchers estimate that more than 35 million people in the U.S. have chronic kidney disease, a condition in which the kidneys are damaged and becoming progressively less efficient at filtering wastes from the blood. Unfortunately, awareness and diagnosis of kidney disease is low. High blood pressure is a major cause of chronic kidney disease, a contributor to its worsening, and a major risk factor for cardiovascular disease.
“Controlling blood pressure is particularly important for the one in seven people in the United States with chronic kidney disease,” says Josef Coresh, MD, PhD, the George W. Comstock Professor in the Bloomberg School’s Department of Epidemiology. “Reducing blood pressure in adults with chronic kidney disease to the level recommended in the new guidelines could also reduce cardiovascular disease among this group.”
The researchers determined from their analysis that Blacks and Asian Americans with chronic kidney disease are more likely than whites to have blood pressure readings above the 2020 Kidney Disease: Improving Global Outcomes target level.
The chief finding was that 69.5 percent of U.S. chronic kidney disease patients, or about 24.5 million individuals, are eligible for blood-pressure lowering according to the 2020 KDIGO guideline—compared with 49.8, percent according to the 2012 Kidney Disease: Improving Global Outcomes guidelines, and 55.6 percent, according to the 2017 American College of Cardiology/American Heart Association guidelines. Thus, about seven million more chronic kidney disease patients are eligible for blood-pressure lowering under the new guidelines.
