Apparent Treatment-Resistant Hypertension and Chronic Kidney Disease: Another Cardiovascular-Renal Syndrome?

Abstract

To identify patients at increased risk of cardiovascular (CV) outcomes, apparent treatment-resistant hypertension (aTRH) is defined as having a blood pressure above goal despite the use of 3 or more antihypertensive therapies of different classes at maximally tolerated doses, ideally including a diuretic. Recent epidemiologic studies in selected populations estimated the prevalence of aTRH as 10% to 15% among patients with hypertension and that aTRH is associated with elevated risk of CV and renal outcomes. Additionally, aTRH and CKD are associated. Although the pathogenesis of aTRH is multifactorial, the kidney is believed to play a significant role. Increased volume expansion, aldosterone concentration, mineralocorticoid receptor activity, arterial stiffness, and sympathetic nervous system activity are central to the pathogenesis of aTRH and are targets of therapies. Although diuretics form the basis of therapy in aTRH, pathophysiologic and clinical data suggest an important role for aldosterone antagonism. Interventional techniques, such as renal denervation and carotid baroreceptor activation, modulate the sympathetic nervous system and are currently in phase III trials for the treatment of aTRH. These technologies are as yet unproven and have not been investigated in relationship to CV outcomes or in patients with CKD.

Swimming Exercise Ameliorates Hypertension-Induced Kidney Dysfunction via Alleviating Renal Interstitial Fibrosis and Apoptosis

“…Early implementation of protective interventions aiming to ameliorate the decline in renal function prior to reaching end-stage renal failure holds great potential to decrease the incidence of CKD, thereby reducing morbidity, mortality, and improving quality of life [29][30][31]. Our study reveals beneficial effects of 8-week swimming exercise on BP control, improving kidney function, alle-viating renal interstitial fibrosis, and cell apoptosis in hypertensive rats.…”

Prevalence and Associated Factors of Resistant Hypertension among Patients with Chronic Kidney Disease: An Example from Cameroon

“…However, studies in Spain and China reported lower prevalence of 13.3% and 11.1% respectively [7,32]. This could be explained first by their larger sample size, the study population and the difference in treatment protocole: contrary to us they included only hypertensive patients with CKD stage 1 to 4 and it is known that RAH is most frequent in patients with CKD stage 5 [21,34].…”

“…Hypertension in CKD is caused either by an excess of intravascular volume or by excessive activation of the reninangiotensin-aldosterone system in relation to the state of sodium/ volume balance [36]. Among these are increased activity of the sympathetic nervous system, increased endothelin production, decreased availability of endothelium-derived vasodilators/ endothelial dysfunction, structural changes of the arteries, renal ischemia [29,34]. All these mechanisms increase with the stage of CKD making HTN more severe and difficult to control with the severity of CKD [34,36].…”

“…Among these are increased activity of the sympathetic nervous system, increased endothelin production, decreased availability of endothelium-derived vasodilators/ endothelial dysfunction, structural changes of the arteries, renal ischemia [29,34]. All these mechanisms increase with the stage of CKD making HTN more severe and difficult to control with the severity of CKD [34,36].…”