title: Incident ESRD and treatment-resistant hypertension: the reasons for geographic and racial differences in stroke (REGARDS) study.
abstract: BACKGROUND
  Studies suggest that treatment-resistant hypertension is common and increasing in prevalence among US adults. Although hypertension is a risk factor for end-stage renal disease (ESRD), few data are available for the association between treatment-resistant hypertension and ESRD risk.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  We analyzed data from 9,974 REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study participants treated for hypertension without ESRD at baseline.
  
  
  METHODS
  Treatment-resistant hypertension was defined as uncontrolled blood pressure (BP) with concurrent use of 3 antihypertensive medication classes including a diuretic or use of 4 or more antihypertensive medication classes including a diuretic regardless of BP.
  
  
  RESULTS
  Incident ESRD was identified by linkage of REGARDS Study participants with the US Renal Data System.
  
  
  METHODS
  During a baseline in-home study visit, BP was measured twice and classes of antihypertensive medication being taken were determined by pill bottle inspection.
  
  
  RESULTS
  During a median follow-up of 6.4 years, there were 152 incident cases of ESRD (110 ESRD cases among 2,147 with treatment-resistant hypertension and 42 ESRD cases among 7,827 without treatment-resistant hypertension). The incidence of ESRD per 1,000 person-years for hypertensive participants with and without treatment-resistant hypertension was 8.86 (95% CI, 7.35-10.68) and 0.88 (95% CI, 0.65-1.19), respectively. After multivariable adjustment, the HR for ESRD comparing hypertensive participants with versus without treatment-resistant hypertension was 6.32 (95% CI, 4.30-9.30). Of participants who developed incident ESRD during follow-up, 72% had treatment-resistant hypertension at baseline.
  
  
  CONCLUSIONS
  BP, estimated glomerular filtration rate, and albuminuria assessed at a single time.
  
  
  CONCLUSIONS
  Individuals with treatment-resistant hypertension are at increased risk for ESRD. Appropriate clinical management strategies are needed to treat treatment-resistant hypertension in order to preserve kidney function in this high-risk group.
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Rikki M
authors.initials: RM
authors.lastname: Tanner
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL.
authors.forename: David A
authors.initials: DA
authors.lastname: Calhoun
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Emmy K
authors.initials: EK
authors.lastname: Bell
authors.affiliation: Atlanta VA Medical Center, Atlanta, GA; Emory University, Atlanta, GA.
authors.forename: C Barrett
authors.initials: CB
authors.lastname: Bowling
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Orlando M
authors.initials: OM
authors.lastname: Gutiérrez
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Marguerite R
authors.initials: MR
authors.lastname: Irvin
authors.affiliation: Medical University of South Carolina, Charleston, SC.
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Lackland
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Oparil
authors.affiliation: Emory University, Atlanta, GA.
authors.forename: William
authors.initials: W
authors.lastname: McClellan
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL.
authors.forename: David G
authors.initials: DG
authors.lastname: Warnock
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL. Electronic address: pmuntner@uab.edu.
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000208:ethnology; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications / Q000208:ethnology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D044469:Racial Groups; D012307:Risk Factors; D020521:Stroke / Q000208:ethnology* / Q000209:etiology; D014481:United States / Q000453:epidemiology
chemical_list: D000959:Antihypertensive Agents
keywords: Treatment-resistant hypertension; antihypertensive medication; end-stage renal disease; hypertension; kidney disease; kidney disease risk factor; renal failure; uncontrolled blood pressure