Apparent treatment-resistant hypertension among elderly Korean hypertensives: an insight from the HIT registry

Choi, S. W.; Mk, Kim; Han, Seong Woo; Han, Sueng‐Han; Lee, B K; Lee, S U; Hur, S.-J.; Lim, Sang Wook; Moon, Keon-Woong; Lee, S G; Lee, S H; Oh, Sung Kyun; Chea, Junie; Joo, Seung Jae; Jo, Myeong Chan; Hong, Kyoung-Soon; Ryu, K.J.

doi:10.1038/jhh.2013.76

Cited by 3 publications

(4 citation statements)

References 18 publications

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“…Most studies reporting associations between CKD and aTRH have been cross-sectional [ 2 , 12 , 15 , 17 , 18 ] with one exception [ 19 ]. They have consistently showed a higher prevalence of aTRH associated with either lower estimated glomerular filtration rates (eGFR) or higher albumin-to-creatinine ratios (ACRs) or both, independent of other major determinants including age, gender, race, smoking, obesity, diabetes, and cardiovascular disease (CVD)[ 2 , 12 , 14 , 15 , 17 , 18 ]. The longitudinal association between the rate of kidney function decline and the risk of resistant hypertension, however, is unknown.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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BackgroundCross-sectional studies show a strong association between chronic kidney disease and apparent treatment-resistant hypertension, but the longitudinal association of the rate of kidney function decline with the risk of resistant hypertension is unknown.MethodsThe population-based Three-City included 8,695 participants older than 65 years, 4265 of them treated for hypertension. We estimated the odds ratios (OR) of new-onset apparent treatment-resistant hypertension, defined as blood pressure ≥ 140/90 mmHg despite use of 3 antihypertensive drug classes or ≥ 4 classes regardless of blood pressure, associated with the mean estimated glomerular filtration rate (eGFR) level and its rate of decline over 4 years, compared with both controlled hypertension and uncontrolled nonresistant hypertension with ≤ 2 drugs. GFR was estimated with three different equations.ResultsBaseline prevalence of apparent treatment-resistant hypertension and of controlled and uncontrolled nonresistant hypertension, were 6.5%, 62.3% and 31.2%, respectively. During follow-up, 162 participants developed apparent treatment-resistant hypertension. Mean eGFR decline with the MDRD equation was 1.5±2.9 mL/min/1.73 m² per year: 27.7% of the participants had an eGFR ≥3 and 10.1% ≥ 5 mL/min/1.73 m² per year. After adjusting for age, sex, obesity, diabetes, and cardiovascular history, the ORs for new-onset apparent treatment-resistant hypertension associated with a mean eGFR level, per 15 mL/min/1.73m² drop, were 1.23 [95% confidence interval 0.91–1.64] compared to controlled hypertension and 1.10 [0.83–1.45] compared to uncontrolled nonresistant hypertension; ORs associated with a decline rate ≥ 3 mL/min/1.73m² per year were 1.89 [1.09–3.29] and 1.99 [1.19–3.35], respectively. Similar results were obtained when we estimated GFR with the CKDEPI and the BIS1 equations. ORs tended to be higher for an eGFR decline rate ≥ 5 mL/min/1.73m² per year.ConclusionThe speed of kidney function decline is associated more strongly than kidney function itself with the risk of apparent treatment-resistant hypertension in the elderly.

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Section: Introductionmentioning

confidence: 99%

“…The longitudinal association between the rate of kidney function decline and the risk of resistant hypertension, however, is unknown. Moreover, although the risk of poor BP control increases greatly with age, few studies have focused on elderly populations [ 7 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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“…Another study using the Korean population reported the prevalence of resistant hypertension as high as 7.9% in a primary care setting [ 14 ]. Choi et al [ 15 ] conducted a prospective multicenter observational study in the Korean elderly population (> 60 years old) who underwent evaluation of secondary hypertension and reported the prevalence of aTRH as 19.1%. In the most recent study using the Korean ambulatory blood pressure monitoring registry (Kor-ABP registry) data, Choi et al [ 16 ] reported that the prevalence of resistant hypertension was 11.9%.…”

Section: Discussionmentioning

confidence: 99%

Apparent treatment-resistant hypertension among ambulatory hypertensive patients: a cross-sectional study from 13 general hospitals

Kim

Park

Shin

et al. 2021

Korean J Intern Med

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Background/Aims: To examine the prevalence and clinical characteristics of apparent treatment-resistant hypertension among ambulatory hypertensive patients. Methods: We enrolled adult ambulatory hypertensive patients at 13 well-qualified general hospitals in Korea from January to June 2012. Apparent resistant hypertension was defined as an elevated blood pressure > 140/90 mmHg with the use of three antihypertensive agents, including diuretics, or ≥ 4 antihypertensives, regardless of the blood pressure. Controlled hypertension was defined as a blood pressure within the target using three antihypertensives, including diuretics. Results: Among 16,915 hypertensive patients, 1,172 (6.9%) had controlled hypertension, and 1,514 (8.9%) had apparent treatment-resistant hypertension. Patients with apparent treatment-resistant hypertension had an earlier onset of hypertension (56.8 years vs. 58.8 years, p = 0.007) and higher body mass index (26.3 kg/m 2 vs. 24.9 kg/m 2 , p < 0.001) than those with controlled hypertension. Drug compliance did not differ between groups. In the multivariable analysis, earlier onset of hypertension (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.97 to 0.99; p < 0.001) and the presence of comorbidities (OR, 2.06; 95% CI, 1.27 to 3.35; p < 0.001), such as diabetes mellitus, ischemic heart disease, heart failure, and chronic kidney disease, were independent predictors. Among the patients with apparent treatment-resistant hypertension, only 5.2% were receiving ≥ 2 antihypertensives at maximally tolerated doses. Conclusions: Apparent treatment-resistant hypertension prevalence is 8.9% among ambulatory hypertensive patients in Korea. An earlier onset of hypertension and the presence of comorbidities are independent predictors. Optimization of medical treatment may reduce the rate of apparent treatment-resistant hypertension.

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“…Several factors contribute to the higher risk of RH in older adults [13,14]. They include age-related vascular changes (i.e., vascular stiffness), neurohormone imbalances, multiple comorbidities (including kidney disease, obesity, and diabetes), poor adherence to medication or polypharmacy, and insufficient lifestyle modifications (especially highsalt diets) [13,14]. Noubiap et al analyzed the prevalence of aTRH by region [11].…”

Section: Epidemiology Of Resistant Hypertensionmentioning

confidence: 99%

Resistant hypertension: consensus document from the Korean society of hypertension

Park,

Shin,

Ihm

et al. 2023

Clin Hypertens

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Although reports vary, the prevalence of true resistant hypertension and apparent treatment-resistant hypertension (aTRH) has been reported to be 10.3% and 14.7%, respectively. As there is a rapid increase in the prevalence of obesity, chronic kidney disease, and diabetes mellitus, factors that are associated with resistant hypertension, the prevalence of resistant hypertension is expected to rise as well. Frequently, patients with aTRH have pseudoresistant hypertension [aTRH due to white-coat uncontrolled hypertension (WUCH), drug underdosing, poor adherence, and inaccurate office blood pressure (BP) measurements]. As the prevalence of WUCH is high among patients with aTRH, the use of out-of-office BP measurements, both ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM), is essential to exclude WUCH. Non-adherence is especially problematic, and methods to assess adherence remain limited and often not clinically feasible. Therefore, the use of HBPM and higher utilization of single-pill fixed-dose combination treatments should be emphasized to improve drug adherence. In addition, primary aldosteronism and symptomatic obstructive sleep apnea are quite common in patients with hypertension and more so in patients with resistant hypertension. Screening for these diseases is essential, as the treatment of these secondary causes may help control BP in patients who are otherwise difficult to treat. Finally, a proper drug regimen combined with lifestyle modifications is essential to control BP in these patients. Graphical Abstract

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Apparent treatment-resistant hypertension among elderly Korean hypertensives: an insight from the HIT registry

Cited by 3 publications

References 18 publications

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

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

Apparent treatment-resistant hypertension among ambulatory hypertensive patients: a cross-sectional study from 13 general hospitals

Resistant hypertension: consensus document from the Korean society of hypertension

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