AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Blood Pressure Goal Attainment Across Cardiovascular-Kidney-Metabolic Syndrome Stages: A Nationally Representative Analysis of US Adults
By DHAMECHA J, Panjwani S, Panja A
Background: Cardiovascular-Kidney-Metabolic (CKM) syndrome recognizes the pathophysiologic interdependence of cardiovascular, kidney, and metabolic disease. How the current <130/80 mmHg blood pressure (BP) threshold is met across CKM stages — and whether attainment has improved over time — remains poorly characterized at the population level. Methods: We analyzed 18,051 US adults with CKM Stage 2-4 (representing 142.9 million Americans) from pooled NHANES cycles 2011-2023. CKM stages were assigned per the 2023 AHA advisory using the race-free CKD-EPI 2021 equation, KDIGO albuminuria/eGFR categories, and AHA PREVENT equations (≥20% 10-year CVD risk defining Stage 3 high-risk equivalent). Survey-weighted modified Poisson regression estimated adjusted prevalence ratios (PRs) for non-attainment. Results: Overall BP goal attainment was 41.0% (95% CI 39.8-42.2). Attainment followed a U-shaped pattern — Stage 2: 40.4% (39.1-41.7); Stage 3: 29.6% (26.6-32.6); Stage 4: 49.8% (47.5-52.1) (p-trend <0.001) — lowest among Stage 3 adults with high subclinical or predicted CVD risk but no established disease, revealing a treatment-intensification gap relative to Stage 4. Among non-attainers, 62.9% were untreated and 37.1% remained above goal on therapy. Severely elevated albuminuria was the strongest correlate of non-attainment (UACR ≥300 mg/g: PR 1.37, 95% CI 1.21-1.55; p<0.001), with effect intensifying across stages (PRs 1.16, 1.34, 1.77 in Stages 2-4; interaction p<0.001). Non-Hispanic Black adults had higher non-attainment than Non-Hispanic White adults (33.2% vs. 41.4%; adjusted PR 1.23, 95% CI 1.16-1.29; p<0.001), consistent with structural rather than biological drivers. Attainment did not improve from 2011-2012 to 2021-2022 (43.3% to 38.9%). Paradoxically, while systolic BP declined in treated patients, diastolic BP rose across all phenotype groups (73.7 to 77.9 mmHg overall; uncontrolled-treated: +0.79 mmHg/cycle, p<0.001), suggesting systolic-focused treatment is neglecting diastolic control. Conclusions: Fewer than half of US adults with CKM syndrome meet the <130/80 mmHg goal, with the largest gap in Stage 3 adults without established CVD. Most non-attainment reflects untreated hypertension. A rising diastolic BP trend despite improving systolic values signals a treatment blind spot. Severe albuminuria and disparities among Non-Hispanic Black adults remain priority intervention targets.