title: Prevalence of apparent treatment-resistant hypertension among individuals with CKD.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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 m(2).
  
  
  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 m(2), 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 m(2), respectively, versus ≥ 60 ml/min per 1.73 m(2) 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.
authors.affiliation: Department of Epidemiology, University of Alabama, Birmingham, Alabama, USA.
authors.forename: Rikki M
authors.initials: RM
authors.lastname: Tanner
authors.forename: David A
authors.initials: DA
authors.lastname: Calhoun
authors.forename: Emmy K
authors.initials: EK
authors.lastname: Bell
authors.forename: C Barrett
authors.initials: CB
authors.lastname: Bowling
authors.forename: Orlando M
authors.initials: OM
authors.lastname: Gutiérrez
authors.forename: Marguerite R
authors.initials: MR
authors.lastname: Irvin
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Lackland
authors.forename: Suzanne
authors.initials: S
authors.lastname: Oparil
authors.forename: David
authors.initials: D
authors.lastname: Warnock
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000652:urine; D000959:Antihypertensive Agents / Q000627:therapeutic use; D044383:Black People; D001794:Blood Pressure; D003404:Creatinine / Q000652:urine; D003920:Diabetes Mellitus / Q000453:epidemiology; D004351:Drug Resistance; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology* / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000503:physiopathology* / Q000652:urine; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D055105:Waist Circumference; D001741:Black or African American
chemical_list: D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D003404:Creatinine