Chronic kidney disease and incident apparent treatment-resistant hypertension among blacks: Data from the Jackson...

Area of Science:

• Nephrology
• Cardiology
• Hypertension Research

Background:

• Apparent treatment-resistant hypertension (aTRH) is a significant concern in managing hypertension, particularly in Black populations.
• The role of chronic kidney disease (CKD) in the development of aTRH among Black patients on antihypertensive medication requires further investigation.

Purpose of the Study:

• To determine if Black patients with CKD have an increased risk of developing aTRH compared to those without CKD.
• To analyze the association between CKD markers (albumin-to-creatinine ratio and estimated glomerular filtration rate) and aTRH risk.

Main Methods:

• Analysis of 1741 participants from the Jackson Heart Study without baseline aTRH on antihypertensive medication.
• aTRH defined by uncontrolled blood pressure on three medication classes or four+ medications. CKD defined by albumin-to-creatinine ratio ≥30 mg/g or eGFR <60 mL/min/1.73 m².
• Multivariable-adjusted hazard ratios were calculated to assess the risk of aTRH over an 8-year follow-up period.

Main Results:

• Over 8 years, 30.5% of participants with CKD and 20.1% without CKD developed aTRH.
• Participants with CKD had a 1.45-fold increased hazard ratio for developing aTRH (95% CI, 1.12-1.86).
• Elevated albumin-to-creatinine ratio (≥30 mg/g) and lower eGFR (<60 mL/min/1.73 m²) were significantly associated with higher aTRH risk.

Conclusions:

• Black patients with CKD on antihypertensive medication have a significantly higher risk of developing aTRH.
• CKD, indicated by albuminuria and reduced eGFR, is an independent risk factor for aTRH in this population.
• These findings underscore the importance of monitoring kidney function in hypertensive patients to mitigate aTRH risk.