The relationship of ethnicity to the prevalence and management of hypertension and associated chronic kidney disease

Abstract

BackgroundThe effect of ethnicity on the prevalence and management of hypertension and associated chronic kidney (CKD) disease in the UK is unknown.MethodsWe performed a cross sectional study of 49,203 adults with hypertension to establish the prevalence and management of hypertension and associated CKD by ethnicity. Routinely collected data from general practice hypertension registers in 148 practices in London between 1/1/07 and 31/3/08 were analysed.ResultsThe crude prevalence of hypertension was 9.5%, and by ethnicity was 8.2% for White, 11.3% for South Asian and 11.1% for Black groups. The prevalence of CKD stages 3-5 among those with hypertension was 22%. Stage 3 CKD was less prevalent in South Asian groups (OR 0.77, 95% CI 0.67 - 0.88) compared to Whites (reference population) with Black groups having similar rates to Whites. The prevalence of severe CKD (stages 4-5) was higher in the South Asian group (OR 1.53, 95% CI 1.17 - 2.0) compared to Whites, but did not differ between Black and White groups. In the whole hypertension cohort, achievement of target blood pressure (< 140/90 mmHg) was better in South Asian (OR 1.43, 95% CI 1.28 - 1.60) and worse in Black groups (OR 0.79, 95% CI 0.74 - 0.84) compared to White patients. Hypertensive medication was prescribed unequally among ethnic groups for any degree of blood pressure control.ConclusionsSignificant variations exist in the prevalence of hypertension and associated CKD and its management between the major ethnic groups. Among those with CKD less than 50% were treated to a target BP of ≤ 130/80 mmHg. Rates of ACE-I/ARB prescribing for those with CKD were less than optimal, with the lowest rates (58.5%) among Black groups.

Research into practice: understanding ethnic differences in healthcare usage and outcomes in general practice

“…The prevalence of chronic kidney disease (CKD) showed significant variation by ethnicity, with higher rates of more severe CKD (stages 4-5) and proteinuria among non-white groups. 12,13 We found that patients with diabetes without proteinuria had a rate of decline very similar to the consensus on age-related (eGFR) decline of 1 ml/min per year, with clinically unimportant differences between ethnic groups. Among those with proteinuria, we found double the rate of decline, with both black African-Caribbean and South Asian patients declining faster than white ethnic groups.…”

Trends in Risk Factor Prevalence and Management Before First Stroke

“…UK observational studies have reported significantly worse control in black patients compared with white patients. 30,31 There was a reduction in patients with untreated risk factors from 40% in 1995-1998 to 17% in 1999-2002, followed by increases until 2010, although the overall trend was not significant. This change from 1995-1998 to 1999-2002 was principally caused by a large increase in hypertension treatment from 52% to 74%.…”

New perspectives on the role of melatonin in human sleep, circadian rhythms and their regulation

“…Approximately 40% of the 55+ population report insomnia and an overall dissatisfaction with quality of sleep (Weyerer and Dilling, 1991) and approximately 30% of the age 55+ population have hypertension (Hull et al, 2011). A bidirectional link exists between insomnia and hypertension; 43% of insomnia patients have hypertension, compared to 19% among good sleepers; 44% of hypertensive patients have insomnia, compared to 19% among normotensive patients (Thase, 2005; Taylor et al, 2007; Roth, 2009; Hoevenaar‐Blom et al, 2011).…”