Resistant Hypertension in Chronic Kidney Disease Patients and Associated Risk Factors; A Single Tertiary Care Hospital Experience
DOI:
https://doi.org/10.51253/pafmj.v74i4.10222Keywords:
Body mass index, chronic kidney disease (CKD), diabetes mellitus, resistant hypertension.Abstract
Objective: To study the frequency of resistant hypertension in chronic kidney disease patients in our population and to analyse associated risk factors contributing to this problem.
Study Design: Cross-sectional study.
Place and Duration of Study: Combined Military Hospital, Multan Pakistan from Jun to Dec 2022.
Methodology: The study included all patients older than 19 who were already diagnosed with hypertension and CKD and were visiting for the usual routine check-up in the Medical/Nephrology OPD.
Results: A total of 325 patients suffering from CKD were included in the study, including 226(69.5%) males and 99(30.5%) females. The mean age of study participants was 56.54±7.15 years. Mean systolic blood pressure was 140.9±19.5 mmHg, whereas mean diastolic blood pressure was 85.12±9.1 mmHg. The average BMI of the participants was measured to be 24.96±4.2 m2/kg. The average/mean eGFR of the case-study participants was calculated to be 47.80±11.6 ml/min. Out of the 325 patients, 141(43.4%) were suffering from resistant hypertension.
Conclusion: The frequency of resistant hypertension in CKD patients who have a positive genealogy of hypertension and associated risk factors of diabetes mellitus and hyperlipidaemia is considerable. Worsening of CKD also increases the proportion of treatment-resistant hypertension in hypertensive patients.
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References
Sarafidis PA, Bakris GL. Resistant hypertension: an overview of evaluation and treatment. J Am Coll Cardiol 2008; 52(22): 1749-1757. https://doi.org/10.1016/j.jacc.2008.08.036
Rossignol P, Massy ZA, Azizi M, Bakris G, Ritz E, Covic A, et al. The double challenge of resistant hypertension and chronic kidney disease. Lancet 2015; 386(10003): 1588-1598.
https://doi.org/10.1016/S0140-6736(15)00418-3
Borrelli S, De Nicola L, Stanzione G, Conte G, Minutolo R. Resistant hypertension in nondialysis chronic kidney disease. Int J Hypertens 2013; 2013. https://doi.org/10.1155/2013/929183
Naseem R, Adam AM, Khan F, Dossal A, Khan I, Khan A, et al. Prevalence and characteristics of resistant hypertensive patients in an Asian population. Indian Heart J 2017; 69(4): 442-446. https://doi.org/10.1016/j.ihj.2017.01.012
Berbari AE, Daouk NA, Jurjus AR. Secondary hypertension: infrequently considered aspects—illicit/recreational substances, herbal remedies, and drug-associated hypertension. Disorders of Blood Pressure Regulation: Phenotypes, Mechanisms, Therap Options 2018: 723-759.
https://doi.org/10.1007/978-3-319-59918-2_43
Hall JE, do Carmo JM, da Silva AA, Wang Z, Hall ME. Obesity, kidney dysfunction and hypertension: mechanistic links. Nat Rev Nephrol 2019; 15(6): 367-385.
https://doi.org/10.1038/s41581-019-0145-4
Zoccali C, Vanholder R, Massy ZA, Ortiz A, Sarafidis P, Dekker FW, et al. The systemic nature of CKD. Nature Reviews Nephrology 2017; 13(6): 344-358.
https://doi.org/10.1038/nrneph.2017.52
Chen J, Bundy JD, Hamm LL, Hsu CY, Lash J, Miller III ER, et al. Inflammation and apparent treatment-resistant hypertension in patients with chronic kidney disease: the results from the CRIC study. Hypertension 2019; 73(4): 785-793.
https://doi.org/10.1161/HYPERTENSIONAHA.118.12358
Pisoni R, Acelajado MC, Cartmill FR, Dudenbostel T, Dell'Italia LJ, Cofield SS, et al. Long-term effects of aldosterone blockade in resistant hypertension associated with chronic kidney disease. J Hum Hypertens 2012; 26(8): 502-506.
https://doi.org/10.1038/jhh.2011.60
De Nicola L, Gabbai FB, Agarwal R, Chiodini P, Borrelli S, Bellizzi V, et al. Prevalence and prognostic role of resistant hypertension in chronic kidney disease patients. J Am Coll Cardiol 2013; 61(24): 2461-2467.
https://doi.org/10.1016/j.jacc.2012.12.061
Burnier M, Viazzi F, Leoncini G, Wuerzner G, Pontremoli R. Renal Parenchymal Disease. Second Hypertens 2020: 1-9. https://doi.org/10.1007/978-3-030-45562-0_1
Thomas G, Xie D, Chen HY, Anderson AH, Appel LJ, Bodana S, et al. Prevalence and prognostic significance of apparent treatment resistant hypertension in chronic kidney disease: report from the chronic renal insufficiency cohort study. Hypertension. 2016; 67(2): 387-396.
https://doi.org/10.1161/hypertensionaha.115.06487
Rossignol P, Massy ZA, Azizi M, Bakris G, Ritz E, Covic A, et al. The double challenge of resistant hypertension and chronic kidney disease. Lancet. 2015; 386(10003): 1588-1598.
https://doi.org/10.1016/S0140-6736(15)00418-3
Chang CP, Li TC, Hang LW, Liang SJ, Lin JJ, Chou CY, et al. The relationships of sleep apnea, hypertension, and resistant hypertension on chronic kidney disease. Medicine 2016; 95(23).
https://doi.org/10.1097%2FMD.0000000000003859
Pathan MK, Cohen DL. Resistant Hypertension: Where are We Now and Where Do We Go from Here?. Integr Blood Press Control 2020; 13: 83–93. https://doi.org/10.2147/IBPC.S223334
Calhoun DA, Jones D, Textor S, Goff DC, Murphy TP, Toto RD, et al. Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension 2008; 51(6): 1403-1419.
https://doi.org/10.1161/hypertensionaha.108.189141
Carey RM, Sakhuja S, Calhoun DA, Whelton PK, Muntner P. Prevalence of apparent treatment-resistant hypertension in the United States: comparison of the 2008 and 2018 American Heart Association Scientific Statements on Resistant Hypertension. Hypertension 2019; 73(2): 424-431.
https://doi.org/10.1161/hypertensionaha.118.12191
Modolo R, de Faria AP, Sabbatini AR, Barbaro NR, Ritter AM, Moreno H. Refractory and resistant hypertension: characteristics and differences observed in a specialized clinic. J Am Soc Hypertens 2015; 9(5): 397-402.
https://doi.org/10.1016/j.jash.2015.03.005
Achelrod D, Wenzel U, Frey S. Systematic review and meta-analysis of the prevalence of resistant hypertension in treated hypertensive populations. Am J Hypertens 2015; 28(3): 355-361. https://doi.org/10.1093/ajh/hpu151
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Copyright (c) 2024 Muhammad Waseem, Farrukh Islam, Ghazal Farrukh, Majida Zia, Asim Saleem, Ali Raza Shah
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