Resistant Hypertension in Chronic Kidney Disease

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higher-risk group with true RH. In a separate report, the authors of the latter study
analyzed largely the same cohort to determine the prognostic effect of baseline and
serial changes in albuminuria among 531 patients with aTRH [ 16 ]. Urinary albumin
was measured by 24-h urine collections at baseline and 2 years. Participants were
divided into normal or microalbuminuric groups using a threshold of >30 mg/24 h

Table 5.1 Definition of terms associated with resistant hypertension adapted from Judd and
Calhoun [ 1 ]; with permission

Term Definition Comments

Resistant hypertension

(RH)

Uncontrolled BP despite maximal

effective dosing of ≥3 medications

of different classes including a

diuretic or controlled BP on ≥ 4

medications

Includes all patients controlled

on ≥4 medications irrespective

of BP

True resistant

hypertension

Same definition as resistant

hypertension emphasizing that

pseudoresistance was excluded by

ambulatory monitoring, optimal

dosing, and assessing

drug-adherence

The term is often necessary to

differentiate from published

data where the term resistant

hypertension is used despite not

excluding pseudoresistance

Apparent treatment

resistant hypertension

(aTRH)

Meeting criteria for resistant

hypertension but unable to exclude

pseudoresistance

Typically used in large

observational studies of office

BP. Many published studies of

resistant hypertension neither

excluded pseudoresistance nor

used this term

Pseudoresistance Uncontrolled office BP while

receiving ≥3 medications in the

setting of white coat hypertension,

medication nonadherence,

improper BP measurement

technique, cuff artifact, and

suboptimal dosing

Presumed to contribute to as

much as 50% of resistant

hypertension

White coat

hypertension

A major cause of pseudoresistance

defined as uncontrolled office BP

with average BP by 24-h

ambulatory monitoring

<130/80 mmHg or home BP

<135/85 mmHg

Masked uncontrolled

hypertension

Controlled office BP

(<140/90 mmHg) with an elevated

average BP by 24-h ambulatory

monitoring >130/80 mmHg or

home BP >135/85 mmHg

Seen in up to 30–60% of

patients with CKD and

hypertension due mainly to

nocturnal hypertension [ 2 , 3 ]

Refractory

hypertension

Uncontrolled BP despite maximal

medical therapy (≥ 5

antihypertensive medications at

maximal effective dosing and of

different class)

The differences in

characteristics between resistant

and refractory hypertension

were recently reviewed [ 4 ]

Abbreviations: BP blood pressure, CKD chronic kidney disease

5 Resistant Hypertension and Outcomes in Patients with and Without Chronic Kidney...