Prevalence of Apparent Treatment-Resistant Hypertension among Individuals with CKD
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Summary: Background and objectives: Apparent treatment-resistant hypertension is defined as systolic/diastolic BP≥140/90 mmHg with concurrent use of three or more antihypertensive medication classes or use of four or more antihypertensive medication classes regardless of BP level. Design, setting, participants, & measurements: The prevalence of apparent treatment-resistant hypertension among Reasons for Geographic and Racial Differences in Stroke study participants treated for hypertension ( n =10,700) was determined by level of estimated GFR and albumin-to-creatinine ratio, and correlates of apparent treatment-resistant hypertension among those participants with CKD were evaluated. CKD was defined as an albumin-to-creatinine ratio≥30 mg/g or estimated GFR<60 ml/min per 1.73 m 2 . Results: The prevalence of apparent treatment-resistant hypertension was 15.8%, 24.9%, and 33.4% for those participants with estimated GFR≥60, 45–59, and <45 ml/min per 1.73 m 2 , respectively, and 12.1%, 20.8%, 27.7%, and 48.3% for albumin-to-creatinine ratio<10, 10–29, 30–299, and ≥300 mg/g, respectively. The multivariable-adjusted prevalence ratios (95% confidence intervals) for apparent treatment-resistant hypertension were 1.25 (1.11 to 1.41) and 1.20 (1.04 to 1.37) for estimated GFR levels of 45–59 and <45 ml/min per 1.73 m 2 , respectively, versus ≥60 ml/min per 1.73 m 2 and 1.54 (1.39 to 1.71), 1.76 (1.57 to 1.97), and 2.44 (2.12 to 2.81) for albumin-to-creatinine ratio levels of 10–29, 30–299, and ≥300 mg/g, respectively, versus albumin-to-creatinine ratio<10 mg/g. After multivariable adjustment, men, black race, larger waist circumference, diabetes, history of myocardial infarction or stroke, statin use, and lower estimated GFR and higher albumin-to-creatinine ratio levels were associated with apparent treatment-resistant hypertension among individuals with CKD. Conclusions: This study highlights the high prevalence of apparent treatment-resistant hypertension among individuals with CKD.
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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”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [16]
Among treated adults with hypertension, prevalent apparent treatment-resistant hypertension occurs in approximately 12% to 15% of population-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”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [16]
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- Authors
- Tanner, R. M., Calhoun, D. A., Bell, E. K., Bowling, C. B., Gutiérrez, O. M., Irvin, M. R., Lackland, D. T., Oparil, S., Warnock, D., & Muntner, P.
- Affiliations
- University of Alabama at Birmingham (US)
- University of Alabama (US)
- Medical University of South Carolina (US)
- Corresponding author
- Tanner, Rikki M.
- Irvin, Marguerite R.
- Muntner, Paul
- ORCID
- Venue
- Clinical Journal of the American Society of Nephrology
- Published
- 2013-09
- Volume
- 8
- Issue
- 9
- Pages
- 1583-1590
- ISSN
- 1555-9041 (ISSN-L)
- PMC
- PMC3805064
- OpenAlex
- W2143986901
- Cited by
- 168
- References
- 30
- Citations by year
- 2026: 6 · 2025: 9 · 2024: 14 · 2023: 14 · 2022: 16 · 2021: 8 · 2020: 17 · 2019: 11 · 2018: 10 · 2017: 16 · 2016: 18 · 2015: 17 · 2014: 10
- FWCI
- 10.19
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Journal of the American Society of Nephrology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Health and Human Services
- Amgen
- Daiichi-Sankyo
- National Institutes of Health
- National Institute of Neurological Disorders and Stroke (U01NS041588)
- Daiichi Sankyo Europe
- 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
- treatment-resistant hypertension, chronic kidney disease, hypertension prevalence, albumin-creatinine ratio, estimated glomerular filtration rate, antihypertensive medication use, albuminuria, waist circumference, Black race, sex differences, cardiovascular risk factors, proteinuria, alcohol consumption, physical activity, medication adherence
- MeSH terms
- Aged, Albuminuria, Antihypertensive Agents, Black or African American, Blood Pressure, Creatinine, Diabetes Mellitus, Drug Resistance, Female, Glomerular Filtration Rate, Humans, Hypertension, Male, Middle Aged, Myocardial Infarction, Sex Factors, United States, Prevalence, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Stroke, Black People, Renal Insufficiency, Chronic, Waist Circumference
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