Persistent Resistant Hypertension Has Worse Renal Outcomes in Chronic Kidney Disease than that Resolved in Two Years: Results from the KNOW-CKD Study

Abstract

Apparent treatment-resistant hypertension (ATRH) is closely related to chronic kidney disease (CKD); however, the long-term outcomes and the effects of improvement in ATRH in patients with CKD are not well understood. We evaluated the relationship between the persistence of ATRH and the progression of CKD. This cohort study enrolled 1921 patients with CKD. ATRH was defined as blood pressure above 140/90 mmHg and intake of three different types of antihypertensive agents, including diuretics, or intake of four or more different types of antihypertensive agents, regardless of blood pressure. We defined ATRH subgroups according to the ATRH status at the index year and two years later. The prevalence of ATRH at baseline was 14.0%. The presence of ATRH at both time points was an independent risk factor for end-point renal outcome (HR, 1.41; 95% CI, 1.04–1.92; p = 0.027). On the other hand, the presence of ATRH at any one of the time points was not statistically significant. In conclusion, persistent ATRH is more important for the prognosis of renal disease than the initial ATRH status. Continuous follow-up and appropriate treatment are important to improve the renal outcomes.

Current apparent treatment‐resistant hypertension in patients undergoing peritoneal dialysis: A multi‐center cross‐sectional study

“…According to ACC/AHA guideline, home BP is suggested to define aTRH, however, many studies have used office BP. 7 , 13 , 14 We also collected office BP and used 140/90 mmHg threshold to evaluate aTRH. As shown in Table 2 , the prevalence was 37.3% based on this criterion, which was lower than that on home BP (42.2%).…”

“…This definition represents a heterogeneous patient group, including those with uncontrolled or controlled BP, pseudo‐resistance (e.g., white‐coat hypertension, inaccurate BP measurements, or elevated BP because of non‐adherence to drugs), and refractory hypertension (RfH) (uncontrolled BP with at least five anti‐hypertensive medication classes) 5,6 . Given the potential pseudo‐resistance, apparent treatment‐resistant hypertension (aTRH) is still the most commonly used term in clinic and in many studies 7–10 . Research of aTRH has been fully evaluated with the prevalence of 0.5%–14.3% in general hypertensive population, and 1.6%–42% in predialysis chronic kidney disease (CKD) patients 7,11–13 .…”

“… 5 , 6 Given the potential pseudo‐resistance, apparent treatment‐resistant hypertension (aTRH) is still the most commonly used term in clinic and in many studies. 7 , 8 , 9 , 10 Research of aTRH has been fully evaluated with the prevalence of 0.5%–14.3% in general hypertensive population, and 1.6%–42% in predialysis chronic kidney disease (CKD) patients. 7 , 11 , 12 , 13 Absolutely, it was associated with a greater risk of cardiovascular events and progression of renal failure.…”

“… 7 , 8 , 9 , 10 Research of aTRH has been fully evaluated with the prevalence of 0.5%–14.3% in general hypertensive population, and 1.6%–42% in predialysis chronic kidney disease (CKD) patients. 7 , 11 , 12 , 13 Absolutely, it was associated with a greater risk of cardiovascular events and progression of renal failure. 8 , 12 , 13 In two studies from hemodialysis (HD) patients, the prevalence seemed to be similar (18%–24%) compared to those on predialysis CKD population.…”

“…1% of the aTRH patients received CCB medication, and the next most frequently class was beta-blocker. As shown in TableS2, the total number of tablets were 4 (3.5-6), 6 (5-8), 9(6)(7)(8)(9)(10)(11), and 11 (9-14) per day in those receiving 3, 4, 5, and 6 antihypertensive drug classes, respectively. Diuretics were used in 425 patients, but not counted as one antihypertensive drug class.…”