engleski

Resistant hypertension in adult hypertensive patients with non-dialysis chronic kidney disease is inadequately recognized condition

Chronic kidney disease (CKD) contributes to the global burden of cardiovascular morbidity (CVM) and mortality. It is documented that blood pressure (BP) control in non-dialysis CKD patients (predominantly CKD stage 3 and 4) plays a key factor in reducing cardiovascular risk and renal disease progression. Studies suggest that there is a lot of patients with unrecognized resistant hypertension (RH). It affects about 10-15% of patients being treated for hypertension by primary care physicians. We investigated what proportions of patients with CKD have unrecognized RH. In this work we evaluated frequency and prognosis of RH among 58 (M:F=27:31, age 67±15 years) hypertensive non-dialysis CKD patients. RH was defined as BP ≥ 130/80 mmHg despite over 3 drugs at full dose or as BP at goal with ≥4 full-dose drugs. All patients with RH had been screened for secondary forms of hypertension according to current guidelines.At beginning of the study eGFR was 39.2±17.3 ml/min/1.73m², BP 167±23/92±14 mmHg. After 12 months BP decreased by 10±19/2±10 mmHg. Detection of RH increased from 25% to 40% due to the significant increment in full-dose antihypertensive medications. Presence of RH at month 12 was associated with greater risk of end-stage renal disease (ESRD). In patient after RD short-term (7 and 28 days) follow-up of renal function demonstrated no evidence of aggravation of renal impairment. In this patient RD diminished night time BP and restored a physiological dipping pattern. Sympathetic activation contributes to the progresion of kidney disease. It is associated with adverse cardiovascular outcomes. There is a burden of unrecognized RH in non-dialysis CKD patients. RD in patients with CKD may provide a valuable tool in slowing the rate of progression of CKD.

resistant hypertension; chronic kidney disease

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