Burden of resistant hypertension in hypertensive patients with non-dialysis chronic kidney disease.

In chronic kidney disease (CKD), no data on resistant hypertension (RH) are so far available despite the high prevalence of uncontrolled hypertension. We evaluated frequency, correlates and prognosis of RH in 300 consecutive incident hypertensive CKD patients in an academic renal clinic. RH was defined as office blood pressure (BP) ≥130/80 mm Hg despite ≥3 drugs at full dose including a diuretic, or as BP at goal with ≥4 full-dose drugs. Patients were evaluated at referral and after 6 months of nephrology management; thereafter, they were included in a renal survival analysis lasting 37.6 months. On referral, glomerular filtration rate was 41.3 ± 16.6 ml/min/1.73 m² and BP 148 ± 23/81 ± 12 mm Hg. After 6 months, BP decreased by 8 ± 23/3 ± 12 mm Hg. From referral to month 6, RH detection increased from 26 to 38% due to the significant increment in full-dose antihypertensive medications (from 2.0, IQR 1.0-3.0 to 2.5, IQR 2.0-3.0). Diabetes and proteinuria predicted the incidence of RH at month 6. Presence of RH at month 6 was associated with greater risk of renal death (HR, 1.85, 95% CI, 1.13-3.03), independent of main clinical features and degree of BP control. In CKD, RH is prevalent and associated with decreased renal survival, independent of BP levels.