• J. Am. Coll. Cardiol. · Jun 2013

    Multicenter Study

    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, and Roberto Minutolo.
    • Department of Nephrology, Second University of Naples, Naples, Italy.
    • J. Am. Coll. Cardiol. 2013 Jun 18;61(24):2461-7.

    ObjectivesThis 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).BackgroundIn CKD, uncontrolled hypertension is a major risk factor, but no study has properly investigated the role of RH.MethodsWe 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).ResultsAge 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 m(2), 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).ConclusionsIn 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.Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

      Pubmed     Free full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…