Key result
Among nondialysis CKD patients with hypertension, 52% had undertreated hypertension and 11.1% had resistant hypertension, indicating undertreatment is the primary cause of uncontrolled BP.
Cross-Sectional (n=4,435)
Yes
Absolute Event Rate: 52% vs 11.1%
Undertreated hypertension, characterized by underutilization of guideline-recommended therapies like RAS blockers and diuretics, contributes more to uncontrolled blood pressure than resistant hypertension in Chinese CKD patients.
Undertreatment drives most uncontrolled BP in nondialysis CKD; supports closer monitoring but leaves open need for prospective trials.
BACKGROUND: Hypertension is prevalent in chronic kidney disease (CKD), but the control of hypertension is suboptimal. We reported the prevalence and characteristics of resistant and undertreated hypertension based on a nationwide survey aiming to improve blood pressure (BP) control. METHODS: Resistant hypertension (RH) was defined as BP above the target (<140/90 mm Hg) despite the use of 3 antihypertensive drugs or achieving the target BP by using ≥4 antihypertensive drugs. Undertreated hypertension was defined as uncontrolled hypertension (unCH) using ≤2 drugs. We compared the characteristics and antihypertensive treatment among different groups (including RH and unCH using ≤2 drugs). Multivariable logistic regression was used to detect factors associated with unCH using ≤2 drugs and RH. RESULTS: 4,435 nondialysis CKD patients with hypertension were analyzed, and 36.9% of participants achieved controlled hypertension (CH) using ≤3 drugs, 11.1% met the criteria for RH, and 52% had unCH despite the use of ≤ 2 antihypertensive drugs. Participants with unCH using ≤ 2 drugs had low usage of renin-angiotensin system blockers (36.8%) and diuretics (5.5%), which was much lower than participants with CH using ≤3 drugs and RH (P< 0.05). After multivariable adjustment, obesity, advanced CKD stages, urinary protein level of ≥1.5 g/24 h, diabetes, and cardiovascular disease were associated with RH in CKD patients (P< 0.05). CONCLUSION: Compared with RH, undertreated hypertension contributes more to the unCH in Chinese CKD patients. It is important to ensure adequate antihypertensive treatment, including choosing antihypertensive drugs, that guidelines recommended.
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Zheng et al. (2018) conducted a cross-sectional in Chronic kidney disease with hypertension (n=4,435). Undertreated hypertension vs. Resistant hypertension was evaluated on Prevalence of undertreated versus resistant hypertension. Among nondialysis CKD patients with hypertension, 52% had undertreated hypertension and 11.1% had resistant hypertension, indicating undertreatment is the primary cause of uncontrolled BP.
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