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. 2022 Oct;17(10):1457-1466.
doi: 10.2215/CJN.04110422. Epub 2022 Sep 9.

Prevalence of Apparent Treatment-Resistant Hypertension in Chronic Kidney Disease in Two Large US Health Care Systems

Jaejin An  1   2 , Manjula Kurella Tamura  3   4 , Michelle C Odden  3   5 , Liang Ni  1 , I-Chun Thomas  3 , Maria E Montez-Rath  4 , John J Sim  2   6
Affiliations

Prevalence of Apparent Treatment-Resistant Hypertension in Chronic Kidney Disease in Two Large US Health Care Systems

Jaejin An et al. Clin J Am Soc Nephrol. 2022 Oct.

Abstract

Background and objectives: More intensive BP goals have been recommended for patients with CKD. We estimated the prevalence of apparent treatment-resistant hypertension among patients with CKD according to the 2017 American College of Cardiology/American Heart Association (ACC/AHA; BP goal <130/80 mm Hg) and 2021 Kidney Disease Improving Global Outcomes (KDIGO; systolic BP <120 mm Hg) guidelines in two US health care systems.

Design, setting, participants, & measurements: We included adults with CKD (an eGFR <60 ml/min per 1.73 m2) and treated hypertension from Kaiser Permanente Southern California and the Veterans Health Administration. Using electronic health records, we identified apparent treatment-resistant hypertension on the basis of (1) BP above the goal while prescribed three or more classes of antihypertensive medications or (2) prescribed four or more classes of antihypertensive medications regardless of BP. In a sensitivity analysis, we required diuretic use to be classified as apparent treatment-resistant hypertension. We estimated the prevalence of apparent treatment-resistant hypertension per clinical guideline and by CKD stage.

Results: Among 44,543 Kaiser Permanente Southern California and 241,465 Veterans Health Administration patients with CKD and treated hypertension, the prevalence rates of apparent treatment-resistant hypertension were 39% (Kaiser Permanente Southern California) and 35% (Veterans Health Administration) per the 2017 ACC/AHA guideline and 48% (Kaiser Permanente Southern California) and 55% (Veterans Health Administration) per the 2021 KDIGO guideline. By requiring a diuretic as a criterion for apparent treatment-resistant hypertension, the prevalence rates of apparent treatment-resistant hypertension were lowered to 31% (Kaiser Permanente Southern California) and 23% (Veterans Health Administration) per the 2017 ACC/AHA guideline. The prevalence rates of apparent treatment-resistant hypertension were progressively higher at more advanced stages of CKD (34%/33%, 42%/36%, 52%/41%, and 60%/37% for Kaiser Permanente Southern California/Veterans Health Administration eGFR 45-59, 30-44, 15-29, and <15 ml/min per 1.73 m2, respectively) per the 2017 ACC/AHA guideline.

Conclusions: Depending on the CKD stage, up to a half of patients with CKD met apparent treatment-resistant hypertension criteria.

Keywords: chronic kidney disease; delivery of health care; hypertension; prevalence.

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Figures

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Graphical abstract
Figure 1.
Figure 1.
Prevalence of apparent treatment-resistant hypertension according to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) and 2021 Kidney Disease Improving Global Outcomes (KDIGO) guidelines.
Figure 2.
Figure 2.
Prevalence of apparent treatment-resistant hypertension (aTRH) by CKD stage according to the 2017 AHA/ACC BP guideline. (A) Kaiser Permanente Southern California; (B) Veterans Health Administration.
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References

    1. Noubiap JJ, Nansseu JR, Nyaga UF, Sime PS, Francis I, Bigna JJ: Global prevalence of resistant hypertension: A meta-analysis of data from 3.2 million patients. Heart 105: 98–105, 2019. 10.1136/heartjnl-2018-313599 - DOI - PubMed
    1. Thomas G, Xie D, Chen HY, Anderson AH, Appel LJ, Bodana S, Brecklin CS, Drawz P, Flack JM, Miller ER 3rd, Steigerwalt SP, Townsend RR, Weir MR, Wright JT Jr, Rahman M; CRIC Study Investigators : Prevalence and prognostic significance of apparent treatment resistant hypertension in chronic kidney disease: Report from the Chronic Renal Insufficiency Cohort study. Hypertension 67: 387–396, 2016. 10.1161/HYPERTENSIONAHA.115.06487 - DOI - PMC - PubMed
    1. Akwo EA, Robinson-Cohen C, Chung CP, Shah SC, Brown NJ, Ikizler TA, Wilson OD, Rowan BX, Shuey MM, Siew ED, Luther JM, Giri A, Hellwege JN, Velez Edwards DR, Roumie CL, Tao R, Tsao PS, Gaziano JM, Wilson PWF, O’Donnell CJ, Edwards TL, Kovesdy CP, Hung AM; VA Million Veteran Program : Association of apparent treatment-resistant hypertension with differential risk of end-stage kidney disease across racial groups in the Million Veteran Program. Hypertension 78: 376–386, 2021. 10.1161/HYPERTENSIONAHA.120.16181 - DOI - PMC - PubMed
    1. Fay KS, Cohen DL: Resistant hypertension in people with CKD: A review. Am J Kidney Dis 77: 110–121, 2021. 10.1053/j.ajkd.2020.04.017 - DOI - PubMed
    1. Carey RM, Sakhuja S, Calhoun DA, Whelton PK, Muntner P: Prevalence of apparent treatment-resistant hypertension in the United States. Hypertension 73: 424–431, 2019. 10.1161/HYPERTENSIONAHA.118.12191 - DOI - PMC - PubMed