Obesity, African American Race, Chronic Kidney Disease, and Resistant Hypertension: The Step Beyond Observed Risk.

Abstract

See related article, pp 387–396 The risk surrounding individuals with blood pressure (BP) that is difficult to control has now been characterized in many different populations in the United States. Prospective cohort studies,1,2 retrospective analyses of large clinical registries,3,4 and subgroup analyses of clinical trials5,6 have consistently identified a higher prevalence of obesity, African American race, chronic kidney disease (CKD), and diabetes mellitus among individuals with apparent treatment-resistant hypertension (ATRH). Despite subtle differences in defining ATRH between studies, individuals with difficult-to-control BP are at increased risk for cardiovascular and kidney events compared with individuals with hypertension being treated with <3 antihypertensive medications.1,2,5,7,8 In this issue of Hypertension , Thomas et al2 expand these risk associations into the CKD population by examining ATRH in the Chronic Renal Insufficiency Cohort (CRIC). The CRIC study included an ethnically diverse group of adults from across the United States with an estimated glomerular filtration rate 20–70 mL/min per 1.73 m2 Hypertension was present in 85.7% of the cohort, highlighting the strong, interdependent relationship between kidney disease and hypertension. Adhering to the American Heart Association definition of resistant hypertension,9 Thomas et al2 reported a prevalence of ATRH of 40.4% among CRIC study participants with hypertension. Although much higher than prevalence estimates for ATRH in general hypertensive populations (12.8%–21.5%), it is no surprise that ATRH is more common in CKD populations. In a cross-sectional analysis of the Kaiser Permanente Southern California health system, CKD had the strongest association with resistant hypertension with an adjusted odds ratio of 1.84 (95% confidence interval [CI] 1.78–1.90).3 When evaluated, CKD is inevitably associated with resistant hypertension.1,3,4 The analyses by Thomas et al2 are well suited to …