Hypertension Control, Apparent Treatment Resistance, and Outcomes in the Elderly Population With Chronic Kidney Disease

IntroductionChronic 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.MethodsWe 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.ResultsAt 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.DiscussionCKD 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.