Analysis shows need for improved hypertension management in chronic kidney disease
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PHILADELPHIA — An analysis of patients with chronic kidney disease showed a high prevalence of treatment-resistant hypertension, emphasizing the need for better management of the condition, according to a presentation at ASN Kidney Week.
The sample, which was from the U.S. TriNetX database, indicated that roughly 20% of the cohort showed treatment-resistant hypertension and that nearly 50% of patients who had an elevated systolic blood pressure did not report taking any antihypertensive medication.
With hypertension commonly recognized as a common symptom of CKD – one that can lead to faster progression and heart failure if left untreated – the findings revealed an unmet need in CKD treatment, according to study co-author Navdeep Tangri, MD, a professor of internal medicine at the University of Manitoba’s Max Rady School of Medicine.
“We just need to optimize how we use drugs. So, we need to use combination drugs and newer therapies. And the data shows when you look at kidney disease, when you target a lower blood pressure, there are fewer cardiovascular events. It’s clear,” Tangri told Healio.
Data that Tangri and his team reviewed showed that, as they expected, the rate of patients taking antihypertensive medication and the number of medications they took, increased according with CKD stage.
“More than half of patients with CKD stage 3, and more than 70% in [stage] 4 and 5 were on at least one medication. More than 20% at stage 3, and more than one in three at stage 4 and 5 were on three or more medications,” Tangri said.
“In fact, what we found was that 20% of patients, so rough roughly 20,000 out of 110,000, met the criteria for resistant hypertension, which meant that they had a blood pressure over 130 [mm Hg] or greater and were on three drugs. There’s a group that needs better control.”
Tangri said that this analysis showed that there needs to be some reconsideration in how clinicians approach and define treatment-resistant hypertension and adjust their treatment plans accordingly to account for this condition.
“I think there's been a major change in the management of blood pressure and kidney disease for the SPRINT trial that was published a couple of years ago. And the message from the guidelines is that we need to be going to 120 [mm Hg], not even 130 [mm Hg],” Tangri said. “We're more liberal in that this study went to 130. The key message for the providers out there is that we're going to need multi-drug therapy if we're trying to get to 120 [mm Hg].”
Reference:
Tangri, N et al. TH-PO1006. Presented at: ASN Kidney Week; Nov. 2-5, 2023; Philadelphia.
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