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

Abstract

It is unclear whether black patients with chronic kidney disease (CKD) vs those without CKD who take antihypertensive medication have an increased risk for apparent treatment-resistant hypertension (aTRH). The authors analyzed 1741 Jackson Heart Study participants without aTRH taking antihypertensive medication at baseline. aTRH was defined as uncontrolled blood pressure while taking three antihypertensive medication classes or taking four or more antihypertensive medication classes, regardless of blood pressure level. CKD was defined as an albumin to creatinine ratio ≥30 mg/g or estimated glomerular filtration rate <60 mL/min/1.73 m² . Over 8 years, 20.1% of participants without CKD and 30.5% with CKD developed aTRH. The multivariable-adjusted hazard ratio for aTRH comparing participants with CKD vs those without CKD was 1.45 (95% CI, 1.12-1.86). Participants with an albumin to creatinine ratio ≥30 vs <30 mg/g (hazard ratio, 1.44; 95% CI, 1.04-2.00) and estimated glomerular filtration rate of 45 to 59 mL/min/1.73 m² and <45 vs ≥60mL/min/1.73 m² (hazard ratio, 1.60 [95% CI, 1.16-2.20] and 2.05 [95% CI, 1.28-3.26], respectively) were more likely to develop aTRH.

Keywords: blood pressure; chronic kidney disease; treatment-resistant hypertension.

Figure 1

Multivariable‐adjusted hazard ratios (HRs) for incident apparent treatment‐resistant hypertension associated with chronic kidney disease (CKD), albumin to creatinine ratio (ACR), and estimated glomerular filtration rate (eGFR) among participants, in subgroups. CKDis defined as an ACR ≥30 mg/g or an eGFR <60 mL/min/1.73 m². MI indicates myocardial infarction