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Many patients with CKD also have treatment-resistant hypertension
More than 50% of patients with moderate chronic kidney disease also have treatment-resistant hypertension, according to findings in a population-based cohort study.
Among those with chronic kidney disease (CKD), there is a higher risk for treatment-resistant hypertension for those who are men; are black; have a larger waist circumference; have diabetes; have a history of MI or stroke; use statins; or have low estimated glomerular filtration rate (eGFR) levels and high albumin-to-creatinine ratio levels, the researchers found.
A common association
The findings “indicate that treatment-resistant hypertension is a common condition among individuals with CKD, suggesting the need for greater awareness of this comorbidity among clinicians,” Rikki M. Tanner, MPH, of the University of Alabama at Birmingham School of Public Health, and colleagues wrote. “The identification of individuals at high risk for developing treatment-resistant hypertension who may benefit from intensive BP monitoring and early therapeutic interventions … should be a high priority.”
The investigators reviewed REGARDS study participants who were receiving treatment for hypertension (n=10,700). The goal of the analysis was to determine the association between levels of eGFR and albumin-to-creatinine ratio with prevalence of treatment-resistant hypertension, and to identify populations within CKD patients at higher risk for treatment-resistant hypertension.
The researchers defined CKD as albumin-to-creatinine ratio ≥30 mg/g or eGFR <60 mL/min/1.73 m2 and treatment-resistant hypertension as BP ≥140 mm Hg/90 mm Hg with concurrent use of three or more antihypertensive medications or use of four or more antihypertensive medications irrespective of BP level.
Links to diabetes, MI and stroke
Overall, 17.9% of participants had treatment-resistant hypertension. The prevalence of treatment-resistant hypertension exceeded 50% in those with both eGFR levels <45 mL/min/1.73 m2 and albumin-to-creatinine ratio ≥300 mg/g. Those with both CKD and treatment-resistant hypertension were more likely to have diabetes or a history of MI or stroke than those with CKD alone, treatment-resistant hypertension alone or neither.
The lower the eGFR level, the more likely the participant had treatment-resistant hypertension, the researchers found. The prevalence of treatment-resistant hypertension was 15.8% for participants with eGFR levels ≥60 mL/min/1.73 m2; 24.9% with levels of 45 mL/min/1.73 m2 to 59 mL/min/1.73 m2 (1.25 multivariable-adjusted prevalence ratio; 95% CI, 1.11-1.41); and 33.4% with levels <45 mL/min/1.73 m2 (1.2 multivariable-adjusted prevalence ratio; 95% CI, 1.04-1.37).
Similarly, the higher the albumin-to-creatinine ratio, the more likely the participant had treatment-resistant hypertension, the researchers found. The prevalence of treatment-resistant hypertension was 12.1% for participants with albumin-to-creatinine ratio <10 mg/g; 20.8% with a ratio of 10 mg/g to 29 mg/g (1.54 multivariable-adjusted prevalence ratio; 95% CI, 1.39-1.71); 27.7% with a ratio of 30 mg/g to 299 mg/g (1.76 multivariable-adjusted prevalence ratio; 95% CI, 1.57-1.97); and 48.3% with a ratio ≥300 mg/g (2.44 multivariable-adjusted prevalence ratio; 95% CI, 2.12-2.81).
Disclosure: See the full study for a list of the researchers’ relevant financial disclosures.