Kidney Function Decline and Apparent Treatment-Resistant Hypertension in the Elderly

Area of Science:

• Nephrology
• Cardiology
• Geriatrics

Background:

• Chronic kidney disease is linked to treatment-resistant hypertension.
• Longitudinal data on kidney function decline and resistant hypertension risk is lacking.

Purpose of the Study:

• To investigate the association between estimated glomerular filtration rate (eGFR) decline and new-onset apparent treatment-resistant hypertension in elderly individuals.
• To compare the risk associated with kidney function level versus its rate of decline.

Main Methods:

• Analysis of 8,695 participants (4,265 treated for hypertension) from the population-based Three-City study.
• Estimation of odds ratios (OR) for new-onset apparent treatment-resistant hypertension based on mean eGFR and its decline rate over 4 years.
• Adjustment for covariates including age, sex, obesity, diabetes, and cardiovascular history.

Main Results:

• A kidney function decline rate of ≥ 3 mL/min/1.73 m² per year was associated with significantly higher odds of new-onset apparent treatment-resistant hypertension (ORs 1.89-1.99).
• Higher decline rates (≥ 5 mL/min/1.73 m² per year) showed a trend towards even higher odds.
• Lower mean eGFR levels showed a weaker association with increased risk.

Conclusions:

• The rate of kidney function decline is a stronger predictor of apparent treatment-resistant hypertension risk than the eGFR level itself in the elderly.
• This highlights the importance of monitoring kidney function decline in hypertensive elderly patients.