© Springer International Publishing AG 2017 59
A. Covic et al. (eds.), Resistant Hypertension in Chronic Kidney Disease,
DOI 10.1007/978-3-319-56827-0_5
Chapter 5
Resistant Hypertension and Outcomes
in Patients with and Without Chronic Kidney
Disease
Aghogho Odudu, Maharajan Raman, and Philip A. Kalra
Introduction
The definitions of aTRH is expanded in other chapters, but we briefly summarize
the terminology in Fig. 5.1 and Table 5.1. The American Heart Association reached
a consensus to define apparent treatment-resistant hypertension (aTRH) as uncon-
trolled BP with three or more antihypertensive drugs or requiring four antihyperten-
sive drugs irrespective of BP [ 5 ]. Uncontrolled BP is defined as >140/90 mmHg in
average-risk populations and >130/80 mmHg in higher-risk populations such as
those with chronic kidney disease (CKD) or diabetes. This dual definition of aTRH
may describe two overlapping but distinct phenotypes. A recent study reported
patients with non-controlled BP had more frequent diabetes (72% vs 49%), higher
plasma glucose, and worse lipid profile [ 6 ]. Reported prevalence of aTRH varies
widely from 3% to 30% of generally hypertensive populations largely due to the
extent that pseudoresistance is excluded to define only “true” resistant hypertension
(RH). There is also inconsistency in whether the lower BP threshold of 130/80 mmHg
that is recommended by some guidelines but not others is used [ 7 , 8 ]. The preva-
lence of aTRH has a stepwise increase with declining stages of CKD or degree of
albuminuria and has typically double the prevalence compared to matched non-
CKD groups [ 9 , 10 ]. The Chronic Renal Insufficiency Cohort recently reported
overall prevalence of ATRH of 40%, rising from 22% to 54% between CKD stages
2 to 4 [ 11 ]. Incidence data confirm that CKD is likely a consequence as well as a
A. Odudu
Division of Cardiovascular Sciences, University of Manchester,
Manchester Academic Health Science Centre, Manchester, UK
Department of Renal Medicine, Salford Royal Hospital, Salford, UK
M. Raman • P.A. Kalra (*)
Department of Renal Medicine, Salford Royal Hospital, Salford, UK
e-mail: [email protected]