title: Burden of resistant hypertension in hypertensive patients with non-dialysis chronic kidney disease.
abstract: OBJECTIVE
  In chronic kidney disease (CKD), no data on resistant hypertension (RH) are so far available despite the high prevalence of uncontrolled hypertension. We evaluated frequency, correlates and prognosis of RH in 300 consecutive incident hypertensive CKD patients in an academic renal clinic.
  
  
  METHODS
  RH was defined as office blood pressure (BP) ≥130/80 mm Hg despite ≥3 drugs at full dose including a diuretic, or as BP at goal with ≥4 full-dose drugs. Patients were evaluated at referral and after 6 months of nephrology management; thereafter, they were included in a renal survival analysis lasting 37.6 months.
  
  
  RESULTS
  On referral, glomerular filtration rate was 41.3 ± 16.6 ml/min/1.73 m² and BP 148 ± 23/81 ± 12 mm Hg. After 6 months, BP decreased by 8 ± 23/3 ± 12 mm Hg. From referral to month 6, RH detection increased from 26 to 38% due to the significant increment in full-dose antihypertensive medications (from 2.0, IQR 1.0-3.0 to 2.5, IQR 2.0-3.0). Diabetes and proteinuria predicted the incidence of RH at month 6. Presence of RH at month 6 was associated with greater risk of renal death (HR, 1.85, 95% CI, 1.13-3.03), independent of main clinical features and degree of BP control.
  
  
  CONCLUSIONS
  In CKD, RH is prevalent and associated with decreased renal survival, independent of BP levels.
authors.affiliation: Division of Nephrology, Second University of Naples, Naples, Italy. luca.denicola@unina2.it
authors.forename: Luca
authors.initials: L
authors.lastname: De Nicola
authors.forename: Silvio
authors.initials: S
authors.lastname: Borrelli
authors.forename: Francis B
authors.initials: FB
authors.lastname: Gabbai
authors.forename: Paolo
authors.initials: P
authors.lastname: Chiodini
authors.forename: Pasquale
authors.initials: P
authors.lastname: Zamboli
authors.forename: Carmela
authors.initials: C
authors.lastname: Iodice
authors.forename: Santo
authors.initials: S
authors.lastname: Vitiello
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Conte
authors.forename: Roberto
authors.initials: R
authors.lastname: Minutolo
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015331:Cohort Studies; D017281:Cost of Illness; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy / Q000401:mortality*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000188:drug therapy / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000959:Antihypertensive Agents