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Prevalence of apparent treatment-resistant hypertension among individuals with CKD

Rikki M Tanner1, David A Calhoun, Emmy K Bell

  • 1Department of Epidemiology, University of Alabama, Birmingham, Alabama, USA.

Clinical Journal of the American Society of Nephrology : CJASN
|July 23, 2013
PubMed

Insights

Apparent treatment-resistant hypertension is common in chronic kidney disease (CKD). Higher albuminuria and lower estimated GFR significantly increase the risk of this condition.

Area of Science:

  • Nephrology
  • Cardiology
  • Epidemiology

Background:

  • Apparent treatment-resistant hypertension (aTRH) is defined as uncontrolled blood pressure despite medication.
  • Chronic kidney disease (CKD) is a significant risk factor for cardiovascular complications.
  • The relationship between CKD and aTRH requires further investigation.

Purpose of the Study:

  • To determine the prevalence of aTRH in individuals with CKD.
  • To evaluate the association between estimated GFR (eGFR) and albumin-to-creatinine ratio (ACR) with aTRH.
  • To identify correlates of aTRH in CKD patients.

Main Methods:

  • Analysis of 10,700 participants from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study.
  • aTRH defined as BP ≥ 140/90 mmHg with ≥3 medication classes or ≥4 regardless of BP.
  • CKD defined as ACR ≥ 30 mg/g or eGFR <60 ml/min/1.73 m².

Main Results:

  • Prevalence of aTRH increased with declining eGFR and increasing ACR.
  • Multivariable-adjusted prevalence ratios showed significant associations between lower eGFR/higher ACR and aTRH.
  • Factors associated with aTRH in CKD included male sex, Black race, larger waist circumference, diabetes, cardiovascular history, statin use, lower eGFR, and higher ACR.

Conclusions:

  • This study underscores the high prevalence of aTRH among individuals with CKD.
  • CKD markers, specifically eGFR and ACR, are strongly associated with aTRH.
  • Identifying and managing aTRH in CKD patients is crucial for cardiovascular risk reduction.
Abstract

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