title: Kidney Function Decline and Apparent Treatment-Resistant Hypertension in the Elderly.
abstract: BACKGROUND
  Cross-sectional studies show a strong association between chronic kidney disease and apparent treatment-resistant hypertension, but the longitudinal association of the rate of kidney function decline with the risk of resistant hypertension is unknown.
  
  
  METHODS
  The population-based Three-City included 8,695 participants older than 65 years, 4265 of them treated for hypertension. We estimated the odds ratios (OR) of new-onset apparent treatment-resistant hypertension, defined as blood pressure ≥ 140/90 mmHg despite use of 3 antihypertensive drug classes or ≥ 4 classes regardless of blood pressure, associated with the mean estimated glomerular filtration rate (eGFR) level and its rate of decline over 4 years, compared with both controlled hypertension and uncontrolled nonresistant hypertension with ≤ 2 drugs. GFR was estimated with three different equations.
  
  
  RESULTS
  Baseline prevalence of apparent treatment-resistant hypertension and of controlled and uncontrolled nonresistant hypertension, were 6.5%, 62.3% and 31.2%, respectively. During follow-up, 162 participants developed apparent treatment-resistant hypertension. Mean eGFR decline with the MDRD equation was 1.5±2.9 mL/min/1.73 m² per year: 27.7% of the participants had an eGFR ≥3 and 10.1% ≥ 5 mL/min/1.73 m² per year. After adjusting for age, sex, obesity, diabetes, and cardiovascular history, the ORs for new-onset apparent treatment-resistant hypertension associated with a mean eGFR level, per 15 mL/min/1.73 m² drop, were 1.23 [95% confidence interval 0.91-1.64] compared to controlled hypertension and 1.10 [0.83-1.45] compared to uncontrolled nonresistant hypertension; ORs associated with a decline rate ≥ 3 mL/min/1.73 m² per year were 1.89 [1.09-3.29] and 1.99 [1.19-3.35], respectively. Similar results were obtained when we estimated GFR with the CKDEPI and the BIS1 equations. ORs tended to be higher for an eGFR decline rate ≥ 5 mL/min/1.73 m² per year.
  
  
  CONCLUSIONS
  The speed of kidney function decline is associated more strongly than kidney function itself with the risk of apparent treatment-resistant hypertension in the elderly.
authors.affiliation: Inserm U1018, CESP, Villejuif, France.|University Paris-Sud, University Paris-Saclay, Villejuif, France.|IRSS/Centre Muraz, Bobo-Dioulasso, Burkina Faso.
authors.forename: Jean
authors.initials: J
authors.lastname: Kaboré
authors.affiliation: Inserm U1018, CESP, Villejuif, France.|University Paris-Sud, University Paris-Saclay, Villejuif, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Metzger
authors.affiliation: Inserm U897-Epidemiology-Biostatistic, Bordeaux, France.|University of Bordeaux, Bordeaux, France.|Clinical Investigation Center - Clinical Epidemiology, Bordeaux, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Helmer
authors.affiliation: Inserm U1061, Montpellier, France, University Montpellier I, Montpellier, France.
authors.forename: Claudine
authors.initials: C
authors.lastname: Berr
authors.affiliation: Inserm U897-Epidemiology-Biostatistic, Bordeaux, France.|University of Bordeaux, Bordeaux, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Tzourio
authors.affiliation: Inserm U1018, CESP, Villejuif, France.|Division of Nephrology, Ambroise Paré University Hospital, Boulogne Billancourt, France.|University Paris-Ouest-UVSQ, Paris, France.
authors.forename: Ziad A
authors.initials: ZA
authors.lastname: Massy
authors.affiliation: Inserm U1018, CESP, Villejuif, France.|University Paris-Sud, University Paris-Saclay, Villejuif, France.
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Stengel
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000453:epidemiology / Q000209:etiology; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015984:Causality; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D003920:Diabetes Mellitus / Q000453:epidemiology; D018450:Disease Progression; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D005919:Glomerular Filtration Rate; D006801:Humans; D006937:Hypercholesterolemia / Q000453:epidemiology; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D006977:Hypertension, Renal / Q000175:diagnosis / Q000453:epidemiology; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D016017:Odds Ratio; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000503:physiopathology; D012680:Sensitivity and Specificity; D012737:Sex Factors
chemical_list: D000959:Antihypertensive Agents; D003404:Creatinine