Persistent Resistant Hypertension Has Worse Renal Outcomes in Chronic Kidney Disease than that Resolved in Two Years: Results from the KNOW-CKD Study.

Su-Hyun Song,Soo-Wan Kim,Eun-Hui Bae,Hong-Sang Choi,Seung-Hyeok Han,Kyu-Beck Lee,Sue-Kyung Park,Kook-Hwan Oh,Suah Sung,Young-Jin Kim,Curie Ahn,Seong-Kwon Ma,Chang-Seong Kim

doi:10.3390/jcm10173998

Abstract

Apparent treatment-resistant hypertension (ATRH) is closely related to chronic kidney disease (CKD); however, the long-term outcomes and the effects of improvement in ATRH in patients with CKD are not well understood. We evaluated the relationship between the persistence of ATRH and the progression of CKD. This cohort study enrolled 1921 patients with CKD. ATRH was defined as blood pressure above 140/90 mmHg and intake of three different types of antihypertensive agents, including diuretics, or intake of four or more different types of antihypertensive agents, regardless of blood pressure. We defined ATRH subgroups according to the ATRH status at the index year and two years later. The prevalence of ATRH at baseline was 14.0%. The presence of ATRH at both time points was an independent risk factor for end-point renal outcome (HR, 1.41; 95% CI, 1.04–1.92; p = 0.027). On the other hand, the presence of ATRH at any one of the time points was not statistically significant. In conclusion, persistent ATRH is more important for the prognosis of renal disease than the initial ATRH status. Continuous follow-up and appropriate treatment are important to improve the renal outcomes.

Highlights

Participants with Apparent treatment-resistant hypertension (ATRH) were older; more likely to be obese; more likely to be past smokers; had lower estimated glomerular filtration rate (eGFR), hemoglobin, and high-density lipoprotein levels; and a higher BUN and random urine protein creatinine ratio (PCR)
Participants with ATRH were more likely to have a medical history of coronary artery disease, diabetes mellitus (DM), and diabetic kidney disease
Male sex (OR, 1.70; 95% confidence interval (CI), 1.24 to 2.32; p = 0.001), lower eGFR (OR, 0.98; 95% CI, 0.98 to 0.99; p < 0.001), higher body mass index (BMI) (OR, 1.16; 95% CI, 1.11 to 1.20; p < 0.001), DM (OR, 1.82; 95% CI, 1.33 to 2.49; p < 0.001), higher uric acid odds ratios (ORs), 1.15; 95% CI, 1.06 to 1.24; p < 0.001), and higher random urine PCR (OR, 1.11; 95% CI, 1.05 to 1.17; p < 0.001) were independent risk factors for ATRH

Summary

Introduction

Hypertension (HTN) is a major risk factor for cardiovascular disease, cerebrovascular accidents, and chronic kidney disease (CKD) [1,2]. It is important to achieve normal blood pressure (BP) through lifestyle modification and pharmacologic treatments. Many individuals with HTN fail to achieve normal BP despite antihypertensive treatments; this condition is called apparent treatment-resistant hypertension (ATRH).

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