Abstract FR461: Hypertension Control Among Participants with Chronic Kidney Disease in the All of Us Research Program

Introduction: Hypertension (HTN) is both a risk factor for and a consequence of chronic kidney disease (CKD). Appropriate HTN control reduces the risk of adverse cardiovascular outcomes, but blood pressure (BP) often remains suboptimal, particularly in CKD. Hypothesis: Poorly controlled HTN, defined as BP >130/80 mm Hg, will be highly prevalent and disparate across socioeconomic groups. Methods: We included participants in the All of Us Research Program with HTN and CKD, defined as estimated glomerular filtration rate (eGFR) by the 2021 CKD-EPI equation <60 mL/min/1.73m 2 based on an outpatient serum creatinine measurement within 90 days of study enrollment. The diagnosis of CKD was confirmed by either a diagnostic code for CKD predating this serum creatinine measurement, or by a second outpatient serum creatinine measurement within 90 days with eGFR <60 mL/min/1.73m 2 . We excluded participants with end-stage kidney disease or with acute kidney injury within 30 days of serum creatinine measurement. We compared demographics, comorbidities, medications, and socioeconomic characteristics of participants with well controlled and poorly controlled HTN based on standardized BP measurement within 90 days of study enrollment. We then performed a multivariable logistic regression analysis to test for associations between race, educational attainment, and income with the outcome of poorly controlled HTN independent of age, sex, eGFR, and cardiovascular comorbidities. Results: Only 39% of participants had well controlled HTN based on AHA guidelines. In unadjusted analyses, participants with poorly controlled HTN had more advanced kidney disease; were more likely to identify as Black; had a lower prevalence of atrial fibrillation, coronary artery disease, and congestive heart failure; were prescribed a similar number of BP medications; and had lower educational attainment and income (Tables 1 and 2). In a fully adjusted multivariable logistic regression model, Black race, lower income, and lower educational attainment were independently associated with poorly controlled HTN (Table 3). Conclusions: Among patients with CKD, the prevalence of poorly controlled HTN is high, with socially vulnerable individuals having increased odds of poor BP control.