#6749 PREVALENCE, AWARENESS, TREATMENT, AND CONTROL OF HYPERTENSION IN OLDER ADULTS WITH CHRONIC KIDNEY DISEASE: THE IRISH LONGITUDINAL STUDY ON AGEING
Authors: Alamin Mohammed , Miri Hamidi , Byrne Mary , Gilligan Robert , Browne Leonard , Sexton Donal , Stack Austin 
Published: June 2023

Abstract

Background and Aims
Hypertension is a well-known modifiable risk factor for chronic kidney disease (CKD) yet effective management remains a challenge. Data on hypertension awareness, treatment and control among CKD patients in Ireland is limited. Therefore, the objective of this study was to determine the prevalence, extent of awareness, treatment and control of hypertension among older adults with CKD in the Irish population.

Method
We utilised cross sectional data from the first wave of The Irish Longitudinal Study on Ageing (TILDA) conducted between 2009 and 2011. Participants aged 50 years or more with complete measurements on serum creatinine and blood pressure (BP) were included (n = 5, 356). CKD was defined as eGFR &lt;60ml/min/1.72m2. Hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg and/or self-reported use of antihypertensive medication. Participants’ awareness and treatment of hypertension were defined using self-report and hypertension control was evaluated as systolic/diastolic blood pressure &lt;140/90 mmHg. We determined the weighted prevalence of hypertension, awareness, treatment, and control using sample weights, and multivariable logistic regression explored associations of demographic, clinical and behavioural characteristics with control of hypertension. Associations were expressed using adjusted odds ratios (OR) with 95% confidence intervals (CIs). Analyses were conducted in Stata and R.

Results
There were 639/5,356 participants [13.3% (95%CI: 12.3-14.4)] with CKD. The weighted prevalence of hypertension was significantly higher in participants with CKD than without CKD (81.8% versus 59.8% respectively, P&lt;0.001). Among those with CKD and hypertension, 70.8% (95% CI: 66.5-74.7) were aware of hypertension, and 83.4% (95% CI 79.9-86.5) were treated with antihypertensive medication. Despite higher levels of awareness and treatment of hypertension in those with CKD, only 50.4% (95% CI 45.4-55.5) of treated subjects had BP &lt;140/90 mmHg. BP control was similarly poor for non-CKD participants at 49.4% (95%CI: 46.9-51.8). The most commonly used medications among treated CKD participants were β-blockers 41.8% (95% CI 36.7-47.1), angiotensin-converting enzyme inhibitors 34.0% (95% CI 29.2-39.2), and angiotensin receptor blockers 33.7% (95% CI: 28.9-38.8). Over half [54.8% (95% CI: 49.5-60.0)] of CKD participants were treated with ≥ 2 antihypertensive medications. In multivariable analysis, the likelihood of BP control (&lt;140/90 mmHg) was lower for older CKD patients [OR: 0.94 (95% CI: 0.90-0.98) per 1 year increase in age], greater for those on combination therapy [OR: 1.87 (95%CI: 1.13-3.1)] and for those with history of cardiovascular disease [OR: 2.33 (95%CI: 1.43-3.82)].

Conclusion
Despite established evidence that control of hypertension can slow the progression of CKD and reduce cardiovascular complications, our results indicate that the prevalence of hypertension in older adults with CKD is high and the control of hypertension is poor and worsens with advancing age. Approximately, one third of participants with CKD were unaware of their hypertensive status and approximately one fifth of participants were untreated.