Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2014 May;63(5):781-8.
doi: 10.1053/j.ajkd.2013.11.016. Epub 2014 Jan 1.

Incident ESRD and treatment-resistant hypertension: the reasons for geographic and racial differences in stroke (REGARDS) study

Rikki M Tanner  1 , David A Calhoun  1 , Emmy K Bell  1 , C Barrett Bowling  2 , Orlando M Gutiérrez  1 , Marguerite R Irvin  1 , Daniel T Lackland  3 , Suzanne Oparil  1 , William McClellan  4 , David G Warnock  1 , Paul Muntner  5
Affiliations
Review

Incident ESRD and treatment-resistant hypertension: the reasons for geographic and racial differences in stroke (REGARDS) study

Rikki M Tanner et al. Am J Kidney Dis. 2014 May.

Abstract

Background: Studies suggest that treatment-resistant hypertension is common and increasing in prevalence among US adults. Although hypertension is a risk factor for end-stage renal disease (ESRD), few data are available for the association between treatment-resistant hypertension and ESRD risk.

Study design: Prospective cohort study.

Setting & participants: We analyzed data from 9,974 REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study participants treated for hypertension without ESRD at baseline.

Predictor: Treatment-resistant hypertension was defined as uncontrolled blood pressure (BP) with concurrent use of 3 antihypertensive medication classes including a diuretic or use of 4 or more antihypertensive medication classes including a diuretic regardless of BP.

Outcome: Incident ESRD was identified by linkage of REGARDS Study participants with the US Renal Data System.

Measurements: During a baseline in-home study visit, BP was measured twice and classes of antihypertensive medication being taken were determined by pill bottle inspection.

Results: During a median follow-up of 6.4 years, there were 152 incident cases of ESRD (110 ESRD cases among 2,147 with treatment-resistant hypertension and 42 ESRD cases among 7,827 without treatment-resistant hypertension). The incidence of ESRD per 1,000 person-years for hypertensive participants with and without treatment-resistant hypertension was 8.86 (95% CI, 7.35-10.68) and 0.88 (95% CI, 0.65-1.19), respectively. After multivariable adjustment, the HR for ESRD comparing hypertensive participants with versus without treatment-resistant hypertension was 6.32 (95% CI, 4.30-9.30). Of participants who developed incident ESRD during follow-up, 72% had treatment-resistant hypertension at baseline.

Limitations: BP, estimated glomerular filtration rate, and albuminuria assessed at a single time.

Conclusions: Individuals with treatment-resistant hypertension are at increased risk for ESRD. Appropriate clinical management strategies are needed to treat treatment-resistant hypertension in order to preserve kidney function in this high-risk group.

Keywords: Treatment-resistant hypertension; antihypertensive medication; end-stage renal disease; hypertension; kidney disease; kidney disease risk factor; renal failure; uncontrolled blood pressure.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Cumulative incidence of end-stage renal disease associated with treatment-resistant hypertension. ESRD: end-stage renal disease
Figure 2
Figure 2
Multivariable adjusted hazard ratios for incident end-stage renal disease associated with treatment-resistant hypertension among Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study participants, in subgroups. Hazard ratios adjusted for age, race, sex, region of residence, education, income, physical activity, current smoking, alcohol use, statin use, waist circumference, diabetes, total cholesterol, high-density lipoprotein cholesterol, c-reactive protein, history of myocardial infarction, and history of stroke.
See this image and copyright information in PMC

Comment in

References

    1. Calhoun DA, Jones D, Textor S, et al. Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension. 2008 Jun;51(6):1403–1419. - PubMed
    1. Egan BM, Zhao Y, Axon RN, Brzezinski WA, Ferdinand KC. Uncontrolled and apparent treatment resistant hypertension in the United States, 1988 to 2008. Circulation. 2011 Aug 30;124(9):1046–1058. - PMC - PubMed
    1. Collins AJ, Foley RN, Herzog C, et al. US Renal Data System 2012 Annual Data Report. American journal of kidney diseases : the official journal of the National Kidney Foundation. 2013 Jan;61(1 Suppl 1):e1–e476. A7. - PubMed
    1. Parikh NI, Hwang SJ, Larson MG, Meigs JB, Levy D, Fox CS. Cardiovascular disease risk factors in chronic kidney disease: overall burden and rates of treatment and control. Archives of internal medicine. 2006 Sep 25;166(17):1884–1891. - PubMed
    1. Coresh J, Wei GL, McQuillan G, et al. Prevalence of high blood pressure and elevated serum creatinine level in the United States: findings from the third National Health and Nutrition Examination Survey (1988–1994) Archives of internal medicine. 2001 May 14;161(9):1207–1216. - PubMed

Publication types

MeSH terms

Substances