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. 2013 Sep;8(9):1583-90.
doi: 10.2215/CJN.00550113. Epub 2013 Jul 18.

Prevalence of apparent treatment-resistant hypertension among individuals with CKD

Rikki M Tanner  1 , David A Calhoun, Emmy K Bell, C Barrett Bowling, Orlando M Gutiérrez, Marguerite R Irvin, Daniel T Lackland, Suzanne Oparil, David Warnock, Paul Muntner
Affiliations

Prevalence of apparent treatment-resistant hypertension among individuals with CKD

Rikki M Tanner et al. Clin J Am Soc Nephrol. 2013 Sep.

Abstract

Background and objectives: Apparent treatment-resistant hypertension is defined as systolic/diastolic BP ≥ 140/90 mmHg with concurrent use of three or more antihypertensive medication classes or use of four or more antihypertensive medication classes regardless of BP level.

Design, setting, participants, & measurements: The prevalence of apparent treatment-resistant hypertension among Reasons for Geographic and Racial Differences in Stroke study participants treated for hypertension (n=10,700) was determined by level of estimated GFR and albumin-to-creatinine ratio, and correlates of apparent treatment-resistant hypertension among those participants with CKD were evaluated. CKD was defined as an albumin-to-creatinine ratio ≥ 30 mg/g or estimated GFR<60 ml/min per 1.73 m(2).

Results: The prevalence of apparent treatment-resistant hypertension was 15.8%, 24.9%, and 33.4% for those participants with estimated GFR ≥ 60, 45-59, and <45 ml/min per 1.73 m(2), respectively, and 12.1%, 20.8%, 27.7%, and 48.3% for albumin-to-creatinine ratio<10, 10-29, 30-299, and ≥ 300 mg/g, respectively. The multivariable-adjusted prevalence ratios (95% confidence intervals) for apparent treatment-resistant hypertension were 1.25 (1.11 to 1.41) and 1.20 (1.04 to 1.37) for estimated GFR levels of 45-59 and <45 ml/min per 1.73 m(2), respectively, versus ≥ 60 ml/min per 1.73 m(2) and 1.54 (1.39 to 1.71), 1.76 (1.57 to 1.97), and 2.44 (2.12 to 2.81) for albumin-to-creatinine ratio levels of 10-29, 30-299, and ≥ 300 mg/g, respectively, versus albumin-to-creatinine ratio<10 mg/g. After multivariable adjustment, men, black race, larger waist circumference, diabetes, history of myocardial infarction or stroke, statin use, and lower estimated GFR and higher albumin-to-creatinine ratio levels were associated with apparent treatment-resistant hypertension among individuals with CKD.

Conclusions: This study highlights the high prevalence of apparent treatment-resistant hypertension among individuals with CKD.

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Figures

Figure 1.
Figure 1.
Prevalence of apparent treatment-resistant hypertension (aTRH) by estimated GFR (eGFR) among Reasons for Geographic and Racial Differences in Stroke (REGARDS) study participants.
Figure 2.
Figure 2.
Prevalence of aTRH by albumin-to-creatinine ratio (ACR) among REGARDS study participants.
Figure 3.
Figure 3.
Prevalence of aTRH by the cross-tabulation of ACR and eGFR among REGARDS study participants.
See this image and copyright information in PMC

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