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Chronic kidney disease: prevalence and prognostic significance of apparent treatment resistant hypertension


The association between apparent treatment resistant hypertension ( ATRH ) and clinical outcomes is not well studied in chronic kidney disease.

Researchers have analyzed data on 3367 hypertensive participants in the Chronic Renal Insufficiency Cohort ( CRIC ) to determine prevalence, associations, and clinical outcomes of ATRH in nondialysis chronic kidney disease patients.

Apparent treatment resistant hypertension was defined as blood pressure greater than or equal to 140/90 mm Hg on greater than or equal to 3 antihypertensives, or use of greater than or equal to 4 antihypertensives with blood pressure at goal at baseline visit.
Prevalence of ATRH was 40.4%.
Older age, male sex, black race, diabetes mellitus, and higher body mass index were independently associated with higher odds of having ATRH.

Participants with ATRH had a higher risk of clinical events than participants without ATRH-composite of myocardial infarction, stroke, peripheral arterial disease, congestive heart failure ( CHF ), and all-cause mortality ( hazard ratio [ 95% confidence interval ], HR=1.38 [ 1.22-1.56 ] ); renal events ( HR=1.28 [ 1.11-1.46 ] ); chronic heart failure ( HR=1.66 [ 1.38-2.00 ] ); and all-cause mortality ( HR=1.24 [ 1.06-1.45 ] ).

The subset of participants with apparent treatment resistant hypertension and blood pressure at goal on greater than or equal to 4 medications also had higher risk for composite of myocardial infarction, stroke, peripheral arterial disease, chronic heart failure, and all-cause mortality ( HR [ 95% CI ], 1.30 [ 1.12-1.51 ] ) and chronic heart failure ( 1.59 [ 1.28-1.99 ] ) than those without ATRH.

Apparent treatment resistant hypertension was associated with significantly higher risk for chronic heart failure and renal events only among those with estimated glomerular filtration rate greater than or equal to 30 mL/min per 1.73 m2.

The findings show that apparent treatment resistant hypertension is common and associated with high risk of adverse outcomes in a cohort of patients with chronic kidney disease.
This underscores the need for early identification and management of patients with apparent treatment resistant hypertension and chronic kidney disease. ( Xagena )

Thomas G et al, Hypertension 2015; Epub ahead of print

XagenaMedicine_2015



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