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Trends in Prevalence of Hypertension by CKD

Hypertension prevalence was higher among adults with CKD for both crude and age-standardized prevalence, with the crude burden at its highest level in recent years at 78.0% among adults with CKD. Hypertension prevalence (crude) appeared higher among older, male, and non-Hispanic Black adults.

Data Source: NHANES

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Hypertension (%), by CKD

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Prevalence of Hypertension by CKD by Overall and CKD (%) National Health and Nutrition Examination Survey
CKD	2001-2004	2005-2008	2009-2012	2013-2016	2017-2020
With CKD	75.7 (95% CI: 72.6-78.8)	75.2 (95% CI: 73.3-77.2)	75.7 (95% CI: 72.1-79.2)	76.0 (95% CI: 72.9-79.1)	78.0 (95% CI: 74.8-81.2)
Without CKD	45.9 (95% CI: 44.0-47.9)	44.8 (95% CI: 43.2-46.5)	44.8 (95% CI: 42.8-46.8)	45.5 (95% CI: 43.9-47.1)	49.2 (95% CI: 46.4-51.9)
Overall	49.9 (95% CI: 47.9-51.8)	49.0 (95% CI: 47.5-50.5)	48.7 (95% CI: 46.6-50.8)	49.8 (95% CI: 48.3-51.3)	53.3 (95% CI: 50.5-56.0)

Prevalence of Hypertension by CKD by Overall and CKD (%) National Health and Nutrition Examination Survey
CKD	2001-2004	2005-2008	2009-2012	2013-2016	2017-2020
With CKD	64.0 (95% CI: 59.7-68.2)	64.5 (95% CI: 61.5-67.6)	62.1 (95% CI: 57.9-66.3)	64.0 (95% CI: 60.2-67.8)	65.1 (95% CI: 59.2-70.9)
Without CKD	49.9 (95% CI: 47.9-51.9)	47.6 (95% CI: 45.8-49.4)	47.0 (95% CI: 45.4-48.6)	47.1 (95% CI: 45.5-48.8)	49.9 (95% CI: 47.3-52.6)
Overall	51.5 (95% CI: 49.6-53.5)	49.8 (95% CI: 48.1-51.4)	48.7 (95% CI: 47.3-50.2)	49.3 (95% CI: 47.8-50.8)	52.0 (95% CI: 49.3-54.6)

Data includes CKD stages 1–5. Estimates were standardized to the 2010 U.S. Census population for adults.

NHANES is a nationally representative, cross-sectional survey that is currently conducted every two years (since 1999) by CDC's National Center for Health Statistics among noninstitutionalized US civilian residents. The survey consists of a standardized in-home interview and a physical examination with blood and urine collected at a mobile examination center. Data were examined by combining two NHANES cycles to represent four-year periods from 2001 to 2016 and the 2017–March 2020 pre-pandemic cycle.

Note: Not all NHANES variables are collected for all years; therefore, some NHANES indicators may not utilize the full 20-year span.

Field	Data
Description of Measure	Overall: Prevalence of Hypertension among U.S. adults. By strata: Prevalence of Hypertension among U.S. adults with CKD.
Data Set	National Health and Nutrition Examination Survey (NHANES).
Population	Noninstitutionalized U.S. adults aged ≥ 18 years. Pregnant women excluded.
Years Included	2001–March 2020.
Numerator	Overall: U.S. adults aged ≥ 18 years with hypertension. By strata: U.S. adults aged ≥ 18 years with CKD and hypertension.
Denominator	Overall: U.S. adults aged ≥ 18 years with data for CKD and hypertension. By strata: U.S. adults aged ≥ 18 years with CKD (eGFR < 60 ml/min/1.73 m² or albuminuria) and data for hypertension.
Definition of CKD	CKD is defined by an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m² or albuminuria (urine albumin to creatinine ratio [UACR] ≥ 30 mg/g). Estimates are based on single eGFR and UACR measurements.
Estimated Glomerular Filtration Rate (eGFR)	Based on the CKD-EPI (2021) equation for calibrated creatinine: eGFR=142 x [min(serum creatinine in mg/dL) /κ, 1)]^α x [max(serum creatinine/κ, 1)]^-1.20 x 0.9938^age x (1.012 if female). κ = 0.7 if female and 0.9 if male α = -0.241 if female and -0.302 if male
Albuminuria	UACR was calculated as urine albumin divided by urine creatinine. Albuminuria is defined as UACR ≥30 mg/g. Urine albumin is measured in random urine collection by fluorescent immunoassay.
Serum Creatinine	Serum creatinine values used for eGFR calculation were standardized against isotope dilution mass spectrometry (IDMS).
Definition of Hypertension	Self-reported hypertension or measured blood pressure ≥ 130/80.¹
Age Standardization	Estimates were standardized to the 2010 U.S. Census population for adults: 18–39 years: 37.1%, 40–59 years: 38.1%, 60–69 years: 12.8%, and 70+ years: 12.0%.
Limitations of Indicator	Albuminuria and kidney function were assessed from one-time cross-sectional measurements, possibly overestimating CKD prevalence.
Analytical Considerations	Appropriate NHANES survey weights were used for all analyses; if relative standard error is greater than 30%, the estimates are not shown. Serum creatinine measurements are assay corrected for NHANES years 2005 and 2006 and prior to be combined with later years.

Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):e13‐e115.