Treatment-Resistant Hypertension in CKD

Patients with chronic kidney disease (CKD) are at risk for treatment-resistant hypertension (TRH), a comorbidity that increases the risk of cardiovascular events. Navdeep Tangri and colleagues conducted an analysis to examine the use of antihypertensive medication in patients with persistent TRH concurrent with CKD, overall and stratified by age.

Results were reported during a poster session at the American Society of Nephrology Kidney Week 2023. The poster was titled Prevalence of Antihypertensive Use in CKD.

The study cohort included adults with CKD in the US TriNex database between 2008 and 2020. Index diagnosis of CKD was the second of two consecutive estimated glomerular filtration rate measurements <75 mL/min/1.73 m² 91 to 730 days apart, or an International Classification of Diseases, Ninth/Tenth Revision code of CKD or dialysis.

Patients with one or more measurement of systolic blood pressure ≥130 mm Hg within 6 months before or any time after the index CKD were eligible for inclusion. TRH was defined as taking three or more antihypertensive medications.

In the cohort of patients with CKD and systolic blood pressure ≥130 mm Hg (n=109,385), mean age was 64 years, 57% were female, 77% were White, and 20% were Black. Participants had a median three systolic blood pressure measurements.

Nearly 50% of participants with systolic blood pressure ≥130 mm Hg did not use any antihypertensive medications, and only 18% used three or more antihypertensive medications.

Overall, the proportion of TRH was 18.6%. Stratified by CKD stage, the proportions were CKD stage 1 and 2, 13.8%; CKD stage 3, 21.5%; CKD stage 4, 35.7%, and CKD stage 5, 37.5%. In the sensitivity analysis, there were modest increases in the proportions

“In a large real-world cohort, TRH was detected in nearly one in five individuals with CKD, and no antihypertensive medication use was observed in nearly half of CKD patients with elevated systolic blood pressure,” the authors said. “An opportunity clearly exists for improved management of TRH in order to avoid adverse clinical outcomes in this high-risk population.”

Source: Tangri N, Kushner PR, Barone S, Arnold M, Chen H, Wittbrodt ET. Prevalence of antihypertensive use in CKD. TH-PO1006. Abstract of a poster presented at the American Society of Nephrology Kidney Week 2023; November 2, 2023; Philadelphia, Pennsylvania. Funding was provided by AstraZeneca plc.