Prevalence and prognostic role of resistant hypertension in chronic kidney disease patients

Luca De Nicola, Francis B. Gabbai, Rajiv Agarwal, Paolo Chiodini, Silvio Borrelli, Vincenzo Bellizzi, Felice Nappi, Giuseppe Conte, Roberto Minutolo

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Abstract

Objectives This study sought to evaluate in chronic kidney disease (CKD) prevalence and prognosis of true resistant hypertension (RH) (i.e., confirmed by ambulatory blood pressure [ABP] monitoring). Background In CKD, uncontrolled hypertension is a major risk factor, but no study has properly investigated the role of RH. Methods We prospectively studied 436 hypertensive CKD patients under nephrology care. Four groups were constituted by combining 24-h ABP with diagnosis of RH (office blood pressure ≥130/80 mm Hg, despite adherence to ≥3 full-dose antihypertensive drugs including a diuretic agent or ≥4 drugs): control (ABP <125/75 mm Hg without RH); pseudoresistance (ABP <125/75 mm Hg with RH); sustained hypertension (ABP ≥125/75 mm Hg without RH); and true resistance (ABP ≥125/75 mm Hg with RH). Endpoints of survival analysis were renal (end-stage renal disease or death) and cardiovascular events (fatal and nonfatal cardiovascular event). Results Age was 65 ± 14 years, men 58%, diabetes 36%, cardiovascular disease 30%, median proteinuria 0.24 (interquartile range 0.09 to 0.83) g/day, estimated glomerular filtration rate 43 ± 20 ml/min/1.73 m2, office blood pressure 146 ± 19/82 ± 12 mm Hg, and 24-h ABP 129 ± 17/72 ± 10 mm Hg. True resistant patients were 22.9%, and pseudoresistant patients were 7.1%, whereas patients with sustained hypertension were 42.9%, and control subjects were 27.1%. Over 57 months of follow-up, 109 cardiovascular events and 165 renal events occurred. Cardiovascular risk (hazard ratio [95% confidence interval]) was 1.24 (0.55 to 2.78) in pseudoresistance, 1.11 (0.67 to 1.84) in sustained hypertension, and 1.98 (1.14 to 3.43) in true resistance, compared with control subjects. Corresponding hazards for renal events were 1.18 (0.45 to 3.13), 2.14 (1.35 to 3.40), and 2.66 (1.62 to 4.37). Conclusions In CKD, pseudoresistance is not associated with an increased cardio-renal risk, and sustained hypertension predicts only renal outcome. True resistance is prevalent and identifies patients carrying the highest cardiovascular risk.

Original languageEnglish
Pages (from-to)2461-2467
Number of pages7
JournalJournal of the American College of Cardiology
Volume61
Issue number24
DOIs
StatePublished - Jun 18 2013

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Chronic Renal Insufficiency
Hypertension
Blood Pressure
Kidney
Ambulatory Blood Pressure Monitoring
Nephrology
Drug and Narcotic Control
Survival Analysis
Glomerular Filtration Rate
Proteinuria
Diuretics
Antihypertensive Agents
Chronic Kidney Failure
Cardiovascular Diseases
Odds Ratio
Confidence Intervals

Keywords

  • ambulatory blood pressure monitoring
  • chronic kidney disease
  • resistant hypertension

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Prevalence and prognostic role of resistant hypertension in chronic kidney disease patients. / De Nicola, Luca; Gabbai, Francis B.; Agarwal, Rajiv; Chiodini, Paolo; Borrelli, Silvio; Bellizzi, Vincenzo; Nappi, Felice; Conte, Giuseppe; Minutolo, Roberto.

In: Journal of the American College of Cardiology, Vol. 61, No. 24, 18.06.2013, p. 2461-2467.

Research output: Contribution to journalArticle

De Nicola, L, Gabbai, FB, Agarwal, R, Chiodini, P, Borrelli, S, Bellizzi, V, Nappi, F, Conte, G & Minutolo, R 2013, 'Prevalence and prognostic role of resistant hypertension in chronic kidney disease patients', Journal of the American College of Cardiology, vol. 61, no. 24, pp. 2461-2467. https://doi.org/10.1016/j.jacc.2012.12.061
De Nicola, Luca ; Gabbai, Francis B. ; Agarwal, Rajiv ; Chiodini, Paolo ; Borrelli, Silvio ; Bellizzi, Vincenzo ; Nappi, Felice ; Conte, Giuseppe ; Minutolo, Roberto. / Prevalence and prognostic role of resistant hypertension in chronic kidney disease patients. In: Journal of the American College of Cardiology. 2013 ; Vol. 61, No. 24. pp. 2461-2467.
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title = "Prevalence and prognostic role of resistant hypertension in chronic kidney disease patients",
abstract = "Objectives This study sought to evaluate in chronic kidney disease (CKD) prevalence and prognosis of true resistant hypertension (RH) (i.e., confirmed by ambulatory blood pressure [ABP] monitoring). Background In CKD, uncontrolled hypertension is a major risk factor, but no study has properly investigated the role of RH. Methods We prospectively studied 436 hypertensive CKD patients under nephrology care. Four groups were constituted by combining 24-h ABP with diagnosis of RH (office blood pressure ≥130/80 mm Hg, despite adherence to ≥3 full-dose antihypertensive drugs including a diuretic agent or ≥4 drugs): control (ABP <125/75 mm Hg without RH); pseudoresistance (ABP <125/75 mm Hg with RH); sustained hypertension (ABP ≥125/75 mm Hg without RH); and true resistance (ABP ≥125/75 mm Hg with RH). Endpoints of survival analysis were renal (end-stage renal disease or death) and cardiovascular events (fatal and nonfatal cardiovascular event). Results Age was 65 ± 14 years, men 58{\%}, diabetes 36{\%}, cardiovascular disease 30{\%}, median proteinuria 0.24 (interquartile range 0.09 to 0.83) g/day, estimated glomerular filtration rate 43 ± 20 ml/min/1.73 m2, office blood pressure 146 ± 19/82 ± 12 mm Hg, and 24-h ABP 129 ± 17/72 ± 10 mm Hg. True resistant patients were 22.9{\%}, and pseudoresistant patients were 7.1{\%}, whereas patients with sustained hypertension were 42.9{\%}, and control subjects were 27.1{\%}. Over 57 months of follow-up, 109 cardiovascular events and 165 renal events occurred. Cardiovascular risk (hazard ratio [95{\%} confidence interval]) was 1.24 (0.55 to 2.78) in pseudoresistance, 1.11 (0.67 to 1.84) in sustained hypertension, and 1.98 (1.14 to 3.43) in true resistance, compared with control subjects. Corresponding hazards for renal events were 1.18 (0.45 to 3.13), 2.14 (1.35 to 3.40), and 2.66 (1.62 to 4.37). Conclusions In CKD, pseudoresistance is not associated with an increased cardio-renal risk, and sustained hypertension predicts only renal outcome. True resistance is prevalent and identifies patients carrying the highest cardiovascular risk.",
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T1 - Prevalence and prognostic role of resistant hypertension in chronic kidney disease patients

AU - De Nicola, Luca

AU - Gabbai, Francis B.

AU - Agarwal, Rajiv

AU - Chiodini, Paolo

AU - Borrelli, Silvio

AU - Bellizzi, Vincenzo

AU - Nappi, Felice

AU - Conte, Giuseppe

AU - Minutolo, Roberto

PY - 2013/6/18

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N2 - Objectives This study sought to evaluate in chronic kidney disease (CKD) prevalence and prognosis of true resistant hypertension (RH) (i.e., confirmed by ambulatory blood pressure [ABP] monitoring). Background In CKD, uncontrolled hypertension is a major risk factor, but no study has properly investigated the role of RH. Methods We prospectively studied 436 hypertensive CKD patients under nephrology care. Four groups were constituted by combining 24-h ABP with diagnosis of RH (office blood pressure ≥130/80 mm Hg, despite adherence to ≥3 full-dose antihypertensive drugs including a diuretic agent or ≥4 drugs): control (ABP <125/75 mm Hg without RH); pseudoresistance (ABP <125/75 mm Hg with RH); sustained hypertension (ABP ≥125/75 mm Hg without RH); and true resistance (ABP ≥125/75 mm Hg with RH). Endpoints of survival analysis were renal (end-stage renal disease or death) and cardiovascular events (fatal and nonfatal cardiovascular event). Results Age was 65 ± 14 years, men 58%, diabetes 36%, cardiovascular disease 30%, median proteinuria 0.24 (interquartile range 0.09 to 0.83) g/day, estimated glomerular filtration rate 43 ± 20 ml/min/1.73 m2, office blood pressure 146 ± 19/82 ± 12 mm Hg, and 24-h ABP 129 ± 17/72 ± 10 mm Hg. True resistant patients were 22.9%, and pseudoresistant patients were 7.1%, whereas patients with sustained hypertension were 42.9%, and control subjects were 27.1%. Over 57 months of follow-up, 109 cardiovascular events and 165 renal events occurred. Cardiovascular risk (hazard ratio [95% confidence interval]) was 1.24 (0.55 to 2.78) in pseudoresistance, 1.11 (0.67 to 1.84) in sustained hypertension, and 1.98 (1.14 to 3.43) in true resistance, compared with control subjects. Corresponding hazards for renal events were 1.18 (0.45 to 3.13), 2.14 (1.35 to 3.40), and 2.66 (1.62 to 4.37). Conclusions In CKD, pseudoresistance is not associated with an increased cardio-renal risk, and sustained hypertension predicts only renal outcome. True resistance is prevalent and identifies patients carrying the highest cardiovascular risk.

AB - Objectives This study sought to evaluate in chronic kidney disease (CKD) prevalence and prognosis of true resistant hypertension (RH) (i.e., confirmed by ambulatory blood pressure [ABP] monitoring). Background In CKD, uncontrolled hypertension is a major risk factor, but no study has properly investigated the role of RH. Methods We prospectively studied 436 hypertensive CKD patients under nephrology care. Four groups were constituted by combining 24-h ABP with diagnosis of RH (office blood pressure ≥130/80 mm Hg, despite adherence to ≥3 full-dose antihypertensive drugs including a diuretic agent or ≥4 drugs): control (ABP <125/75 mm Hg without RH); pseudoresistance (ABP <125/75 mm Hg with RH); sustained hypertension (ABP ≥125/75 mm Hg without RH); and true resistance (ABP ≥125/75 mm Hg with RH). Endpoints of survival analysis were renal (end-stage renal disease or death) and cardiovascular events (fatal and nonfatal cardiovascular event). Results Age was 65 ± 14 years, men 58%, diabetes 36%, cardiovascular disease 30%, median proteinuria 0.24 (interquartile range 0.09 to 0.83) g/day, estimated glomerular filtration rate 43 ± 20 ml/min/1.73 m2, office blood pressure 146 ± 19/82 ± 12 mm Hg, and 24-h ABP 129 ± 17/72 ± 10 mm Hg. True resistant patients were 22.9%, and pseudoresistant patients were 7.1%, whereas patients with sustained hypertension were 42.9%, and control subjects were 27.1%. Over 57 months of follow-up, 109 cardiovascular events and 165 renal events occurred. Cardiovascular risk (hazard ratio [95% confidence interval]) was 1.24 (0.55 to 2.78) in pseudoresistance, 1.11 (0.67 to 1.84) in sustained hypertension, and 1.98 (1.14 to 3.43) in true resistance, compared with control subjects. Corresponding hazards for renal events were 1.18 (0.45 to 3.13), 2.14 (1.35 to 3.40), and 2.66 (1.62 to 4.37). Conclusions In CKD, pseudoresistance is not associated with an increased cardio-renal risk, and sustained hypertension predicts only renal outcome. True resistance is prevalent and identifies patients carrying the highest cardiovascular risk.

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