Abstract
BackgroundCross-sectional studies show a strong association between chronic kidney disease and apparent treatment-resistant hypertension, but the longitudinal association of the rate of kidney function decline with the risk of resistant hypertension is unknown.MethodsThe population-based Three-City included 8,695 participants older than 65 years, 4265 of them treated for hypertension. We estimated the odds ratios (OR) of new-onset apparent treatment-resistant hypertension, defined as blood pressure ≥ 140/90 mmHg despite use of 3 antihypertensive drug classes or ≥ 4 classes regardless of blood pressure, associated with the mean estimated glomerular filtration rate (eGFR) level and its rate of decline over 4 years, compared with both controlled hypertension and uncontrolled nonresistant hypertension with ≤ 2 drugs. GFR was estimated with three different equations.ResultsBaseline prevalence of apparent treatment-resistant hypertension and of controlled and uncontrolled nonresistant hypertension, were 6.5%, 62.3% and 31.2%, respectively. During follow-up, 162 participants developed apparent treatment-resistant hypertension. Mean eGFR decline with the MDRD equation was 1.5±2.9 mL/min/1.73 m² per year: 27.7% of the participants had an eGFR ≥3 and 10.1% ≥ 5 mL/min/1.73 m² per year. After adjusting for age, sex, obesity, diabetes, and cardiovascular history, the ORs for new-onset apparent treatment-resistant hypertension associated with a mean eGFR level, per 15 mL/min/1.73m² drop, were 1.23 [95% confidence interval 0.91–1.64] compared to controlled hypertension and 1.10 [0.83–1.45] compared to uncontrolled nonresistant hypertension; ORs associated with a decline rate ≥ 3 mL/min/1.73m² per year were 1.89 [1.09–3.29] and 1.99 [1.19–3.35], respectively. Similar results were obtained when we estimated GFR with the CKDEPI and the BIS1 equations. ORs tended to be higher for an eGFR decline rate ≥ 5 mL/min/1.73m² per year.ConclusionThe speed of kidney function decline is associated more strongly than kidney function itself with the risk of apparent treatment-resistant hypertension in the elderly.
Highlights
Despite use of an increasing number of antihypertensive medications, uncontrolled hypertension remains common and one of the most important risk factors for end-stage renal disease and cardiovascular mortality in persons with chronic kidney disease (CKD)[1,2,3,4,5,6,7]
After adjusting for age, sex, obesity, diabetes, and cardiovascular history, the odds ratios (OR) for new-onset apparent treatment-resistant hypertension associated with a mean estimated glomerular filtration rate (eGFR) level, per 15 mL/min/ 1.73m2 drop, were 1.23 [95% confidence interval 0.91–1.64] compared to controlled hypertension and 1.10 [0.83–1.45] compared to uncontrolled nonresistant hypertension; ORs
The speed of kidney function decline is associated more strongly than kidney function itself with the risk of apparent treatment-resistant hypertension in the elderly
Summary
Despite use of an increasing number of antihypertensive medications, uncontrolled hypertension remains common and one of the most important risk factors for end-stage renal disease and cardiovascular mortality in persons with chronic kidney disease (CKD)[1,2,3,4,5,6,7]. Most studies reporting associations between CKD and aTRH have been cross-sectional [2,12,15,17,18] with one exception [19] They have consistently showed a higher prevalence of aTRH associated with either lower estimated glomerular filtration rates (eGFR) or higher albumin-to-creatinine ratios (ACRs) or both, independent of other major determinants including age, gender, race, smoking, obesity, diabetes, and cardiovascular disease (CVD)[2,12,14,15,17,18]. Cross-sectional studies show a strong association between chronic kidney disease and apparent treatment-resistant hypertension, but the longitudinal association of the rate of kidney function decline with the risk of resistant hypertension is unknown
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