Hypertension Control, Apparent Treatment Resistance, and Outcomes in the Elderly Population With Chronic Kidney Disease
Chronic kidney disease (CKD) is often associated with poor hypertension control and treatment resistance, but whether CKD modifies the effect of hypertension control on outcomes is unknown. Methods: We studied 10-year mortality and cardiovascular events according to hypertension control status and C...
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| Format: | Article |
| Language: | English |
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Elsevier
2017-03-01
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| Series: | Kidney International Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468024916301620 |
| _version_ | 1828880836805525504 |
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| author | Jean Kaboré Marie Metzger Catherine Helmer Claudine Berr Christophe Tzourio Tilman B. Drueke Ziad A. Massy Bénédicte Stengel |
| author_facet | Jean Kaboré Marie Metzger Catherine Helmer Claudine Berr Christophe Tzourio Tilman B. Drueke Ziad A. Massy Bénédicte Stengel |
| author_sort | Jean Kaboré |
| collection | DOAJ |
| description | Chronic kidney disease (CKD) is often associated with poor hypertension control and treatment resistance, but whether CKD modifies the effect of hypertension control on outcomes is unknown.
Methods: We studied 10-year mortality and cardiovascular events according to hypertension control status and CKD (glomerular filtration rate <60 ml/min/1.73m2) in 4262 community-dwelling individuals (40% men) more than 65 years of age.
Results: At baseline, 19% had CKD, and 31.2% had controlled hypertension on ≤3 antihypertensive drugs, 62.3% uncontrolled hypertension ≥140/90 mm Hg on ≤2 drugs, and 6.5% apparent treatment-resistant hypertension (aTRH) ≥140/90 mm Hg with ≥3 drugs or use of ≥4 drugs regardless of level. There were 1115 deaths (305 total cardiovascular deaths) and 274 incident nonfatal or fatal strokes or coronary events. Compared to the reference group (controlled hypertension and no CKD), participants without CKD and with uncontrolled hypertension or aTRH had adjusted hazard ratios for all-cause mortality of 0.86 (0.74−1.01) and 1.09 (0.82−1.46), and those with CKD and controlled or uncontrolled hypertension, or aTRH, of 1.33 (1.06−1.68), 1.14 (0.93−1.39), and 1.34 (0.98−1.85), respectively. Participants with aTRH and CKD had a risk of coronary death more than 3 times higher than that of the reference group; participants with aTHR, with or without CKD, had a risk of stroke more than twice as high, and those with CKD but controlled hypertension a 2 times higher risk for cardiovascular deaths from other causes.
Discussion: CKD does not appear to amplify the risk of stroke and coronary events associated with aTRH in this older population. The reasons for excess cardiovascular mortality from other causes associated with controlled hypertension require further study. |
| first_indexed | 2024-12-13T09:56:25Z |
| format | Article |
| id | doaj.art-52c1f8accaea4af880efc29952376249 |
| institution | Directory Open Access Journal |
| issn | 2468-0249 |
| language | English |
| last_indexed | 2024-12-13T09:56:25Z |
| publishDate | 2017-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Kidney International Reports |
| spelling | doaj.art-52c1f8accaea4af880efc299523762492022-12-21T23:51:47ZengElsevierKidney International Reports2468-02492017-03-012218019110.1016/j.ekir.2016.10.006Hypertension Control, Apparent Treatment Resistance, and Outcomes in the Elderly Population With Chronic Kidney DiseaseJean Kaboré0Marie Metzger1Catherine Helmer2Claudine Berr3Christophe Tzourio4Tilman B. Drueke5Ziad A. Massy6Bénédicte Stengel7CESP, Inserm UMR1018 Team 5, University of Paris-Sud, UVSQ, University Paris-Saclay, Villejuif, FranceCESP, Inserm UMR1018 Team 5, University of Paris-Sud, UVSQ, University Paris-Saclay, Villejuif, FranceInserm, UMR1219 Population Health, Bordeaux, FranceInserm U1061, Montpellier, FranceInserm, UMR1219 Population Health, Bordeaux, FranceCESP, Inserm UMR1018 Team 5, University of Paris-Sud, UVSQ, University Paris-Saclay, Villejuif, FranceCESP, Inserm UMR1018 Team 5, University of Paris-Sud, UVSQ, University Paris-Saclay, Villejuif, FranceCESP, Inserm UMR1018 Team 5, University of Paris-Sud, UVSQ, University Paris-Saclay, Villejuif, FranceChronic kidney disease (CKD) is often associated with poor hypertension control and treatment resistance, but whether CKD modifies the effect of hypertension control on outcomes is unknown. Methods: We studied 10-year mortality and cardiovascular events according to hypertension control status and CKD (glomerular filtration rate <60 ml/min/1.73m2) in 4262 community-dwelling individuals (40% men) more than 65 years of age. Results: At baseline, 19% had CKD, and 31.2% had controlled hypertension on ≤3 antihypertensive drugs, 62.3% uncontrolled hypertension ≥140/90 mm Hg on ≤2 drugs, and 6.5% apparent treatment-resistant hypertension (aTRH) ≥140/90 mm Hg with ≥3 drugs or use of ≥4 drugs regardless of level. There were 1115 deaths (305 total cardiovascular deaths) and 274 incident nonfatal or fatal strokes or coronary events. Compared to the reference group (controlled hypertension and no CKD), participants without CKD and with uncontrolled hypertension or aTRH had adjusted hazard ratios for all-cause mortality of 0.86 (0.74−1.01) and 1.09 (0.82−1.46), and those with CKD and controlled or uncontrolled hypertension, or aTRH, of 1.33 (1.06−1.68), 1.14 (0.93−1.39), and 1.34 (0.98−1.85), respectively. Participants with aTRH and CKD had a risk of coronary death more than 3 times higher than that of the reference group; participants with aTHR, with or without CKD, had a risk of stroke more than twice as high, and those with CKD but controlled hypertension a 2 times higher risk for cardiovascular deaths from other causes. Discussion: CKD does not appear to amplify the risk of stroke and coronary events associated with aTRH in this older population. The reasons for excess cardiovascular mortality from other causes associated with controlled hypertension require further study.http://www.sciencedirect.com/science/article/pii/S2468024916301620cardiovascularchronic kidney diseasehypertension |
| spellingShingle | Jean Kaboré Marie Metzger Catherine Helmer Claudine Berr Christophe Tzourio Tilman B. Drueke Ziad A. Massy Bénédicte Stengel Hypertension Control, Apparent Treatment Resistance, and Outcomes in the Elderly Population With Chronic Kidney Disease Kidney International Reports cardiovascular chronic kidney disease hypertension |
| title | Hypertension Control, Apparent Treatment Resistance, and Outcomes in the Elderly Population With Chronic Kidney Disease |
| title_full | Hypertension Control, Apparent Treatment Resistance, and Outcomes in the Elderly Population With Chronic Kidney Disease |
| title_fullStr | Hypertension Control, Apparent Treatment Resistance, and Outcomes in the Elderly Population With Chronic Kidney Disease |
| title_full_unstemmed | Hypertension Control, Apparent Treatment Resistance, and Outcomes in the Elderly Population With Chronic Kidney Disease |
| title_short | Hypertension Control, Apparent Treatment Resistance, and Outcomes in the Elderly Population With Chronic Kidney Disease |
| title_sort | hypertension control apparent treatment resistance and outcomes in the elderly population with chronic kidney disease |
| topic | cardiovascular chronic kidney disease hypertension |
| url | http://www.sciencedirect.com/science/article/pii/S2468024916301620 |
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