Incident ESRD and Treatment-Resistant Hypertension: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

• Type of Material: Article
• Authors: Rikki M. Tanner, University of Alabama Birmingham; David A. Calhoun, University of Alabama Birmingham; Emmy K. Bell, University of Alabama Birmingham; Barrett Bowling, Emory University; Orlando M. Gutierrez, University of Alabama Birmingham; Marguerite R. Irvin, University of Alabama Birmingham; Daniel T. Lackland, Medical University of South Carolina; Suzanne Oparil, University of Alabama Birmingham; William McClellan, Emory University; David G. Warnock, University of Alabama Birmingham; Paul Muntner, University of Alabama Birmingham
• Language: English
• Date: 2014-05-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1053/j.ajkd.2013.11.016
• Title of Journal or Parent Work: American Journal of Kidney Diseases
• ISSN: 0272-6386
• Volume: 63
• Issue: 5
• Start Page: 781
• End Page: 788
• Grant/Funding Information: Additional funding was provided by an investigator-initiated grant-in-aid from Amgen Corporation.; This research project is supported by a cooperative agreement U01 NS041588 from the National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH).
• Keywords: Treatment-resistant hypertension; Life Sciences & Biomedicine; hypertension; kidney disease; CHRONIC KIDNEY-DISEASE; PREVALENCE; Science & Technology; AMERICAN; BLOOD-PRESSURE CONTROL; antihypertensive medication; kidney disease risk factor; Urology & Nephrology; BURDEN; uncontrolled blood pressure; end-stage renal disease; renal failure; RISK
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Medicine and Surgery

Abstract

Background: Studies suggest that treatment-resistant hypertension is common and increasing in prevalence among US adults. Although hypertension is a risk factor for end-stage renal disease (ESRD), few data are available for the association between treatment-resistant hypertension and ESRD risk. Study Design: Prospective cohort study. Setting & Participants: We analyzed data from 9,974 REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study participants treated for hypertension without ESRD at baseline. Predictor: Treatment-resistant hypertension was defined as uncontrolled blood pressure (BP) with concurrent use of 3 antihypertensive medication classes including a diuretic or use of 4 or more antihypertensive medication classes including a diuretic regardless of BP. Outcome: Incident ESRD was identified by linkage of REGARDS Study participants with the US Renal Data System. Measurements: During a baseline in-home study visit, BP was measured twice and classes of antihypertensive medication being taken were determined by pill bottle inspection. Results: During a median follow-up of 6.4 years, there were 152 incident cases of ESRD (110 ESRD cases among 2,147 with treatment-resistant hypertension and 42 ESRD cases among 7,827 without treatment-resistant hypertension). The incidence of ESRD per 1,000 person-years for hypertensive participants with and without treatment-resistant hypertension was 8.86 (95% CI, 7.35-10.68) and 0.88 (95% CI, 0.65-1.19), respectively. After multivariable adjustment, the HR for ESRD comparing hypertensive participants with versus without treatment-resistant hypertension was 6.32 (95% CI, 4.30-9.30). Of participants who developed incident ESRD during follow-up, 72% had treatment-resistant hypertension at baseline. Limitations: BP, estimated glomerular filtration rate, and albuminuria assessed at a single time. Conclusions: Individuals with treatment-resistant hypertension are at increased risk for ESRD. Appropriate clinical management strategies are needed to treat treatment-resistant hypertension in order to preserve kidney function in this high-risk group.