Prevalence of Apparent Therapy-Resistant Hypertension and Its Effect on Outcome in Patients With Chronic Kidney Disease.
New options recently became available for treatment of uncontrolled blood pressure. Information on the prevalence of therapy-resistant hypertension (TRH) in patients with chronic kidney disease and its consequences is relevant to balance risks and benefits of potential new therapies. Data of 788 patients with chronic kidney disease came from a multicenter study investigating the effect on outcome of an integrated multifactorial approach delivered by nurse practitioners added to usual care versus usual care alone. Blood pressure was measured at the office and during 30 minutes using an automated oscillometric device. Apparent TRH (aTRH) was defined as a blood pressure ≥130/80 mm Hg despite treatment with ≥3 antihypertensive drugs, including a diuretic or treatment with ≥4 antihypertensive drugs. Participants were followed up for the occurrence of myocardial infarction, stroke or cardiovascular mortality (composite cardiovascular end point) and end-stage renal disease. aTRH was present in 34% (office blood pressure) and in 32% (automated measurements). During 5.3 years of follow-up, 17% of patients with aTRH reached a cardiovascular end point and 27% reached end-stage renal disease. aTRH lead to a 1.5-fold higher risk (95% confidence interval, 0.8-3.0) of a cardiovascular end point compared with controlled hypertensives in multivariable-adjusted analysis. aTRH increased end-stage renal disease risk 2.3-fold (95% confidence interval, 1.4-3.7). During 4 years of follow-up, the prevalence of aTRH did not decline in either treatment group. The prevalence of aTRH is high in patients with chronic kidney disease even after optimization of nephrologist care. The presence of TRH is related to a substantially increased risk of renal and cardiovascular outcomes.
From the Department of Nephrology and Hypertension (E.d.B., A.D.v.Z., P.J.B.) and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, Utrecht, the Netherlands; and Department of Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands (J.F.M.W.). E.deBeus-2@umcutrecht.nl.
Esther
E
de Beus
From the Department of Nephrology and Hypertension (E.d.B., A.D.v.Z., P.J.B.) and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, Utrecht, the Netherlands; and Department of Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands (J.F.M.W.).
Michiel L
ML
Bots
From the Department of Nephrology and Hypertension (E.d.B., A.D.v.Z., P.J.B.) and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, Utrecht, the Netherlands; and Department of Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands (J.F.M.W.).
Arjan D
AD
van Zuilen
From the Department of Nephrology and Hypertension (E.d.B., A.D.v.Z., P.J.B.) and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, Utrecht, the Netherlands; and Department of Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands (J.F.M.W.).
Jack F M
JF
Wetzels
From the Department of Nephrology and Hypertension (E.d.B., A.D.v.Z., P.J.B.) and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, Utrecht, the Netherlands; and Department of Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands (J.F.M.W.).
Peter J
PJ
Blankestijn
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D004232:Diuretics / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology* / Q000503:physiopathology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D009722:Nurse Practitioners; D009819:Office Visits; D015995:Prevalence; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000503:physiopathology; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology; D017211:Treatment Failure
D000959:Antihypertensive Agents; D004232:Diuretics
blood pressure; cardiovascular diseases; hypertension resistant to conventional therapy; renal insufficiency, chronic; risk