Blood pressure control in the Kidney Research Network before and after the 2017 guideline change

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. Results: A total of 725 adult patients were eligible for this analysis. Prior to 2017, 14% of patients demonstrated normal blood pressures compared to 10% in the post-2017 cohort. However, following adjustment, the post-2017 era had better blood pressure control. Blood pressure medication usage, particularly calcium channel blockers, increased after the guideline change. Conclusions: Blood pressure control in patients with glomerular disease remains poor. Publication of updated blood pressure management guidelines has not yet led to substantial improvement in blood pressure control in this patient population, though it has led to an increase in the number of medications prescribed.