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

Abstract

Background: Resistant arterial hypertension (RAH) is common in patients with chronic kidney disease (CKD). We aimed to study the prevalence and associated factors of RAH in patients with CKD in 2 referral hospitals in Cameroon. Material and method: This was a cross-sectional and analytical study, from December 2020 to May 2021. All consenting patients over 18 years of age with hypertension and CKD stage 2-5 ND was included. Socio demographic, clinical and biological data were collected. Patients were considered to have RAH if they were on 4 antihypertensive drugs or a patient on 3 antihypertensive drugs, including 1 diuretic who presented with office blood pressure ≥ 140/90 mmhg and BP ≥ 135/85 mmhg after home BP self-measurement. Home BP self-measurement was performed using an OMRON brand electronic BP monitor every morning and evening for three consecutive days and the average of the 18 values was calculated. Chi-2 and exact Fischer tests was used to assess the association between variables. p<0,05 was considered significant. Results: A total of 194 patients were included, with 62.89% male. The mean age was 61.89 (13.13) years; 34.54% (67/194) had CKD stage 3a, 26.80% (52/194) stage 3b, 15.46% (30/194) stage 4 and 21.13% (41/194) stage 5. Hypertension: 47.93% (93/194), diabetes: 21.65%, (42/194) and chronic glomerulonephritis: 11.34% (22/194) were the main presumed etiologies of CKD. The prevalence of RAH was 26.29% (51/194), and age >60 years (p=0,001), CKD grade 5 (p=0,000), presence of diabetes (p=0,000), dyslipidemia (p=0,006), obesity (p=0,001) and smoking (p=0,001) were associated factors. Conclusion: RAH is frequent amongst CKD patients, and it is associated with cardiovascular risk factors and severity of CKD. It is necessary to identify these patients and put measure to control BP especially in those with risk factors.