• Lancet · Oct 2015

    Review

    The double challenge of resistant hypertension and chronic kidney disease.

    • Patrick Rossignol, Ziad A Massy, Michel Azizi, George Bakris, Eberhard Ritz, Adrian Covic, David Goldsmith, Gunnar H Heine, Kitty J Jager, Mehmet Kanbay, Francesca Mallamaci, Alberto Ortiz, Raymond Vanholder, Andrzej Wiecek, Carmine Zoccali, Gérard Michel London, Bénédicte Stengel, Denis Fouque, ERA-EDTA EURECA-m working group, Red de Investigación Renal (REDINREN) network, and Cardiovascular and Renal Clinical Trialists (F-CRIN INI-CRCT) network.
    • INSERM Centre d'Investigations Cliniques (CIC)-1433, and INSERM U1116, Nancy, France; Institut Lorrain du Cœur et des Vaisseaux, CHU Nancy, Vandoeuvre lès Nancy, France; Université de Lorraine, Nancy, France; Association Lorraine pour le Traitement de l'Insuffisance Rénale, Vandoeuvre lès Nancy, France. Electronic address: p.rossignol@chu-nancy.fr.
    • Lancet. 2015 Oct 17;386(10003):1588-98.

    AbstractResistant hypertension is defined as blood pressure above goal despite adherence to a combination of at least three optimally dosed antihypertensive medications, one of which is a diuretic. Chronic kidney disease is the most frequent of several patient factors or comorbidities associated with resistant hypertension. The prevalence of resistant hypertension is increased in patients with chronic kidney disease, while chronic kidney disease is associated with an impaired prognosis in patients with resistant hypertension. Recommended low-salt diet and triple antihypertensive drug regimens that include a diuretic, should be complemented by the sequential addition of other antihypertensive drugs. New therapeutic innovations for resistant hypertension, such as renal denervation and carotid barostimulation, are under investigation especially in patients with advanced chronic kidney disease. We discuss resistant hypertension in chronic kidney disease stages 3-5 (ie, patients with an estimated glomerular filtration rate below 60 mL/min per 1·73 m(2) and not on dialysis), in terms of worldwide epidemiology, outcomes, causes and pathophysiology, evidence-based treatment, and a call for action.Copyright © 2015 Elsevier Ltd. All rights reserved.

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