Angiotensin-Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Use Among Hypertensive US Adults With Albuminuria.
Angiotensin-Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Use Among Hypertensive US Adults With Albuminuria.
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DOI：
10.1161/hypertensionaha.120.16281
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发表时间：
2021-01
期刊：
影响因子：
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通讯作者：
Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team
中科院分区：
文献类型：
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作者：
Chu CD;Powe NR;McCulloch CE;Banerjee T;Crews DC;Saran R;Bragg-Gresham J;Morgenstern H;Pavkov ME;Saydah SH;Tuot DS;Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team
自2003年以来，美国高血压指南推荐血管紧张素转换酶抑制剂（ACEi）或血管紧张素受体阻滞剂（ARB）作为蛋白尿（尿白蛋白/肌酐比值≥300 mg/g）的一线降压治疗。为了检查指南一致性ACEi/ARB使用的国家趋势，我们研究了参加2001-2018年国家健康和营养检查调查的高血压（定义为自我报告的高血压，收缩压≥140 mmHg或舒张压≥90 mmHg，或使用抗高血压药物）成人。在纳入的20，538名成人中，2001-2006年白蛋白尿≥300 mg/g的患病率为2.8%，2007-2012年为2.8%，2013-2018年为3.2%。在白蛋白尿≥300 mg/g的患者中，2001-2018年糖尿病患者、非糖尿病患者或总体患者中接受ACEi/ARB治疗的比例未观察到一致趋势。2013-2018年，在蛋白尿≥300 mg/g的情况下，糖尿病成人中ACEi/ARB的使用率为55.3%（95% CI; 46.8%-63.6%），非糖尿病成人中为33.4%（95% CI; 23.1%-45.5%）。根据美国人口统计，这些估计值代表了160万目前未接受ACEi/ARB治疗的白蛋白尿≥300 mg/g的成人，其中近一半人没有糖尿病。ACEi/ARB利用不足代表了高血压和蛋白尿成人预防保健服务的一个显著差距，并没有随着时间的推移而发生实质性变化。
Since 2003, US hypertension guidelines have recommended angiotensin converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) as first-line antihypertensive therapy in the presence of albuminuria (urine albumin/creatinine ratio ≥300 mg/g). To examine national trends in guideline-concordant ACEi/ARB utilization, we studied adults participating in the National Health and Nutrition Examination Surveys 2001-2018 with hypertension (defined by self-report of high blood pressure, systolic blood pressure ≥140 mmHg or diastolic ≥90 mmHg, or use of antihypertensive medications). Among 20,538 included adults, prevalence of albuminuria ≥300 mg/g was 2.8% in 2001-2006, 2.8% in 2007-2012, and 3.2% in 2013-2018. Among those with albuminuria ≥300 mg/g, no consistent trends were observed for the proportion receiving ACEi/ARB treatment from 2001-2018 among persons with diabetes, without diabetes, or overall. In 2013-2018, ACEi/ARB usage in the setting of albuminuria ≥300 mg/g was 55.3% (95% CI; 46.8%-63.6%) among adults with diabetes and 33.4% (95% CI; 23.1%-45.5%) among those without diabetes. Based on US population counts, these estimates represent 1.6 million adults with albuminuria ≥300 mg/g currently not receiving ACEi/ARB therapy, nearly half of whom do not have diabetes. ACEi/ARB underutilization represents a significant gap in preventive care delivery for adults with hypertension and albuminuria that has not substantially changed over time.