RT Journal Article
SR Electronic
T1 Prevalence of Apparent Treatment-Resistant Hypertension among Individuals with CKD
JF Clinical Journal of the American Society of Nephrology
JO CLIN J AM SOC NEPHROL
FD American Society of Nephrology
SP 1583
OP 1590
DO 10.2215/CJN.00550113
VO 8
IS 9
A1 Tanner, Rikki M.
A1 Calhoun, David A.
A1 Bell, Emmy K.
A1 Bowling, C. Barrett
A1 Gutiérrez, Orlando M.
A1 Irvin, Marguerite R.
A1 Lackland, Daniel T.
A1 Oparil, Suzanne
A1 Warnock, David
A1 Muntner, Paul
YR 2013
UL http://cjasn.asnjournals.org/content/8/9/1583.abstract
AB Background and objectives Apparent treatment-resistant hypertension is defined as systolic/diastolic BP≥140/90 mmHg with concurrent use of three or more antihypertensive medication classes or use of four or more antihypertensive medication classes regardless of BP level.Design, setting, participants, & measurements The prevalence of apparent treatment-resistant hypertension among Reasons for Geographic and Racial Differences in Stroke study participants treated for hypertension (n=10,700) was determined by level of estimated GFR and albumin-to-creatinine ratio, and correlates of apparent treatment-resistant hypertension among those participants with CKD were evaluated. CKD was defined as an albumin-to-creatinine ratio≥30 mg/g or estimated GFR<60 ml/min per 1.73 m2.Results The prevalence of apparent treatment-resistant hypertension was 15.8%, 24.9%, and 33.4% for those participants with estimated GFR≥60, 45–59, and <45 ml/min per 1.73 m2, respectively, and 12.1%, 20.8%, 27.7%, and 48.3% for albumin-to-creatinine ratio<10, 10–29, 30–299, and ≥300 mg/g, respectively. The multivariable-adjusted prevalence ratios (95% confidence intervals) for apparent treatment-resistant hypertension were 1.25 (1.11 to 1.41) and 1.20 (1.04 to 1.37) for estimated GFR levels of 45–59 and <45 ml/min per 1.73 m2, respectively, versus ≥60 ml/min per 1.73 m2 and 1.54 (1.39 to 1.71), 1.76 (1.57 to 1.97), and 2.44 (2.12 to 2.81) for albumin-to-creatinine ratio levels of 10–29, 30–299, and ≥300 mg/g, respectively, versus albumin-to-creatinine ratio<10 mg/g. After multivariable adjustment, men, black race, larger waist circumference, diabetes, history of myocardial infarction or stroke, statin use, and lower estimated GFR and higher albumin-to-creatinine ratio levels were associated with apparent treatment-resistant hypertension among individuals with CKD.Conclusions This study highlights the high prevalence of apparent treatment-resistant hypertension among individuals with CKD.