Resistant Arterial Hypertension in Patients With Chronic Kidney Disease: Prevalence, Prognostic Significance, Reasons and Approaches to Antihypertensive Therapy

Abstract

Arterial hypertension (AH) resistant to drug therapy is the phenotype of uncontrolled AH, in which patients receiving at least 3 antihypertensive drugs, including a diuretic, maintain blood pressure above the target level. Initially, the term refractory hypertension was also used to refer to resistant hypertension. Recently, however, refractory hypertension has been isolated into a separate phenotype of difficult to treat hypertension, which is defined as insufficient control of target blood pressure, despite the use of at least 5 different mechanisms of antihypertensive drugs, including long-acting diuretic and antagonist of mineralcorticoid receptors. Resistant hypertension is detected in 10–15 % of all hypertensive patients receiving drug therapy, and is often found in patients with chronic kidney disease. Hypertension can be a cause and/or consequence of kidney damage and is typical of most patients with chronic kidney disease. The lack of control of target blood pressure in a significant proportion of hypertensive patients with CKD who receive at least 3 antihypertensive drugs of different mechanisms of action indicates a lack of effectiveness of antihypertensive therapy, which not only accelerates the loss of renal function, but also significantly worsens the prognosis, contributing to such people risk of cardiovascular and renal complications. The review presents data on the prevalence, prognostic value of resistant hypertension in patients with chronic kidney disease, features of its formation and approaches to increasing the effectiveness of antihypertensive therapy in this patient population.

Uncontrolled Arterial Hypertension: Kidney, Neurohormonal Imbalance, and Approaches to Antihypertensive Drug Therapy

“…По данным, полученным в крупных популяционных исследованиях, использовавших в качестве критерия целевое значение АД <140 / 90 мм рт. ст., резистентная АГ выявляется у 12,8-16,9 % всех больных АГ, получающих медикаментозную терапию, и наиболее часто встречается у пациентов с ожирением, сахарным диабетом (СД) и хронической болезнью почек (ХБП) [4]. Частота выявления рефрактерной АГ колеблется при этом в пределах 0,5-1,4 %, возрастая до 2,09 % у больных СД и 2,22 % у лиц с альбуминурией (отношение альбумин / креатинин в моче ≥30 мг / г креатинина) [5][6][7].…”