Apparent hypertension resistant to common treatment in chronic kidney disease

The researchers concluded in a research paper examining its prevalence in Clinical Journal of the American Society of Nephrology.

These patients “would be eligible for treatment intensification based on contemporary guidelines,” writes Jigen Ann, MD of Kaiser Permanente Southern California in Pasadena. “This would result in regimens of four or more antihypertensive drugs for many patients.”

Dr. Ann’s team studied adult patients with chronic kidney disease who treated high blood pressure from two large integrated health systems: 44,543 from Kaiser Permanente Southern California and 241,465 from the Veterans Health Administration (VHA). The prevalence rates of treatment-resistant apparent hypertension in CKD were 39% in the Kaiser Permanente group and 35% in the VHA group based on the 2017 ACC/AHA guidelines, and 48% and 55% based on the 2021 KDIGO guidelines, Dr. Ann and colleagues reported.

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The investigators defined clear treatment-resistant hypertension as blood pressure above target while prescribing 3 or more classes of antihypertensive drugs or prescribing 4 or more classes of antihypertensive drugs regardless of blood pressure.

Among the patients with chronic kidney disease and obvious treatment-resistant hypertension, most had uncontrolled, resistant hypertension or treatment-resistant hypertension, the researchers wrote. ‚ÄúThese data point to an opportunity to improve treatment and outcomes in a population vulnerable to the negative effects of altitude [blood pressure]. ”

Regarding study limitations, the investigators acknowledged that their study used desktop blood pressure measurements extracted from electronic health records and lacked data for out-of-office blood pressure measurements, which may be a more accurate assessment of patients’ blood pressure. “Because of the differences between the office [blood pressure] Compared to home and home [blood pressure] measurements, the prevalence of apparent treatment-resistant hypertension may be overestimated.”

The authors said their study is one of the largest and most diverse to date examining apparent treatment-resistant hypertension among CKD patients.


An J, Tamura MK, Odden MC, et al. Prevalence of obvious treatment-resistant hypertension in chronic kidney disease in two large United States health care systems. Clean J Am Sok Nephrole. Published online September 9, 2022. doi: 10.2215 / CJN.04110422

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