Cited by 190Blood Pressure and Hypertension StudiesChronic Kidney Disease and DiabetesHormonal Regulation and Hypertension

Prevalence and Prognostic Significance of Apparent Treatment Resistant Hypertension in Chronic Kidney Disease: Report From the Chronic Renal Insufficiency Cohort Study

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Thomas, George, Xie, Dawei, Chen, Hsiang-Yu, Anderson, Amanda H., Appel, Lawrence J., Bodana, Shirisha, Brecklin, Carolyn S., Drawz, Paul +7 more·2016·Hypertension

Abstract

The association between apparent treatment resistant hypertension (ATRH) and clinical outcomes is not well studied in chronic kidney disease. We analyzed data on 3367 hypertensive participants in the Chronic Renal Insufficiency Cohort (CRIC) to determine prevalence, associations, and clinical outcomes of ATRH in nondialysis chronic kidney disease patients. ATRH was defined as blood pressure ≥140/90 mm Hg on ≥3 antihypertensives, or use of ≥4 antihypertensives with blood pressure at goal at baseline visit. Prevalence of ATRH was 40.4%. Older age, male sex, black race, diabetes mellitus, and higher body mass index were independently associated with higher odds of having ATRH. Participants with ATRH had a higher risk of clinical events than participants without ATRH—composite of myocardial infarction, stroke, peripheral arterial disease, congestive heart failure (CHF), and all-cause mortality (hazard ratio [95% confidence interval], 1.38 [1.22–1.56]); renal events (1.28 [1.11–1.46]); CHF (1.66 [1.38–2.00]); and all-cause mortality (1.24 [1.06–1.45]). The subset of participants with ATRH and blood pressure at goal on ≥4 medications also had higher risk for composite of myocardial infarction, stroke, peripheral arterial disease, CHF, and all-cause mortality (hazard ratio [95% confidence interval], (1.30 [1.12–1.51]) and CHF (1.59 [1.28–1.99]) than those without ATRH. ATRH was associated with significantly higher risk for CHF and renal events only among those with estimated glomerular filtration rate ≥30 mL/min per 1.73 m 2 . Our findings show that ATRH is common and associated with high risk of adverse outcomes in a cohort of patients with chronic kidney disease. This underscores the need for early identification and management of patients with ATRH and chronic kidney disease.

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Crossref · 10.1161/hypertensionaha.115.06487

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  • Around 40% of patients with chronic kidney disease have resistant hypertension, which does not respond to standard treatments.

    “Around 40% of patients with CKD have resistant hypertension103, which does not respond to standard treatments.”

    From Renal nerves in physiology, pathophysiology and interoception (2025) · cites this paper as [103]

    The Results report apparent treatment-resistant hypertension in 40.4% of hypertensive participants in the CRIC cohort, not 40% of all patients with CKD. They also report that 47.5% of those classified as having it had blood pressure at goal on four or more medications, so the claim that it does not respond to treatment does not describe the whole group. The source calls the condition 'apparent' because it could not exclude causes of apparent resistance. (LLM, conf=0.90)

    Experimental — accuracy not yet measured
  • The mechanism by which canagliflozin and other SGLT2 inhibitors lower blood pressure is likely multifactorial, with differing contributing factors in people with and without chronic kidney disease.

    “The mechanism by which canagliflozin and other SGLT2 inhibitors lower BP is likely multifactorial with differing contributing factors in people with and without CKD.8,23”
  • Among treated adults with hypertension, prevalent apparent treatment-resistant hypertension occurs in 15% to 18% of clinic-based samples.

    “Among treated adults with hypertension, prevalent aTRH occurs in ≈12% to 15% of population-based13–16 and 15% to 18% of clinic-based reports.17–20”
  • Prevalent apparent treatment-resistant hypertension occurs in a higher percentage of population- and clinic-based samples when an at-risk group is selected, such as patients with treated hypertension and chronic kidney disease.

    “Prevalent aTRH occurs in a higher percentage of the population- and clinic-based samples when an at-risk group is selected, for example, patients with treated hypertension and chronic kidney disease (CKD).16,19”
  • In patients with chronic kidney disease, resistant hypertension is associated with higher risk of myocardial infarction, stroke, peripheral arterial disease, heart failure, and all-cause mortality compared with patients without resistant hypertension.

    “In patients with CKD, RH is associated with higher risk of myocardial infarction, stroke, peripheral arterial disease, heart failure, and all-cause mortality compared with patients without RH.19”

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Authors
Thomas, G., Xie, D., Chen, H.-Y., Anderson, A. H., Appel, L. J., Bodana, S., Brecklin, C. S., Drawz, P., Flack, J. M., Miller, E. R., Steigerwalt, S. P., Townsend, R. R., Weir, M. R., Wright, J. T., & Rahman, M.
Affiliations
University of Maryland, Baltimore (US)
Venue
Hypertension
Published
2016-02
Volume
67
Issue
2
Pages
387-396
ISSN
  • 0194-911X (ISSN-L)
  • 1524-4563
OpenAlex
W2214725575
Cited by
190
References
38
Citations by year
2026: 20 · 2025: 18 · 2024: 21 · 2023: 21 · 2022: 19 · 2021: 13 · 2020: 31 · 2019: 17 · 2018: 12 · 2017: 7 · 2016: 9 · 2015: 1
FWCI
7.04
Type
journal article
Language
en
Open access
Locations
  • Hypertension (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (UL1TR000114, UL1TR000433, UL1TR000424, UL1TR000003, UL1TR000439)
  • National Institute of General Medical Sciences (P30GM103337)
  • National Institute of Diabetes and Digestive and Kidney Diseases (U01DK060990, R01DK139225, U01DK060984, U01DK060902, U01DK060980, U01DK061022, U01DK060963, U01DK061021, U01DK061028)
  • National Center for Research Resources (M01RR000080, UL1RR024131, M01RR016500, UL1RR029879, M01RR 16500)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
Keywords
apparent treatment-resistant hypertension, chronic kidney disease, hypertension prevalence, congestive heart failure, all-cause mortality, renal events, myocardial infarction, stroke, peripheral arterial disease, antihypertensive medication use, estimated glomerular filtration rate, CRIC, risk factors
MeSH terms
Aged, Aged, 80 and over, Antihypertensive Agents, Blood Pressure, Female, Follow-Up Studies, Humans, Hypertension, Male, Middle Aged, Prognosis, Prospective Studies, Risk Factors, United States, Prevalence, Renal Insufficiency, Chronic

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