The double challenge of resistant hypertension and chronic kidney disease

Rossignol, Patrick; Massy, Ziad A.; Azizi, Michel; Bakris, George L.; Ritz, Eberhard; Covic, Adrian; Goldsmith, David; Heine, Gunnar H.; Jager, Kitty J.; Kanbay, Mehmet; Mallamaci, Francesca; Ortíz, Alberto; Vanholder, Raymond; Wiȩcek, Andrzej; Zoccali, Carmine; London, Gérard M.; Stengel, Bénédicte; Fouque, Denis

doi:10.1016/s0140-6736(15)00418-3

Cited by 151 publications

(97 citation statements)

References 91 publications

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“…Resistant hypertension (RH), defined as a blood pressure (BP) above recommended levels despite optimal combination of at least three different drugs including a diuretic [1][2][3], is a relatively frequent finding in patients at cardiovascular risk (CVR), especially in the presence of diabetes and chronic kidney disease (CKD) [4][5][6]. The prevalence of RH has been reported to vary considerably, from 10 to 40% [3,7], depending on the clinical setting and confounding factors such as poor adherence to treatment.…”

Section: Introductionmentioning

confidence: 99%

“…ATRH has been associated to worse cardiovascular (CV) morbidity and mortality [9][10] and accelerated loss of renal function in CKD patients [6,11]. In a recent retrospective study conducted on a large general population cohort, the presence of RH was associated with a 23% greater risk of developing a cardiovascular event as well as a 25% greater risk of reaching end-stage renal disease (ESRD).…”

Section: Introductionmentioning

confidence: 99%

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Apparent Treatment Resistant Hypertension, Blood Pressure Control and the Progression of Chronic Kidney Disease in Patients with Type 2 Diabetes

Viazzi

Greco

Ceriello

et al. 2018

Kidney Blood Press Res

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Background/Aims: Apparent treatment resistant hypertension (aTRH) is highly prevalent in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD). The impact of aTRH and achievement of recommended blood pressure (BP) values on the rate of glomerular filtration rate (eGFR) loss in CKD patients is poorly known. To assess the role of aTRH and time-updated BP control (BPC) on the progression of CKD in patients with T2D and hypertension (HT) in real life clinical practice. Methods: Clinical records from a total of 2,778 diabetic patients with HT and stage 3 CKD (i.e. baseline eGFR values between 30 and 60 ml/min) and regular visits during a four-year follow-up were analyzed. The association between BPC (i.e. 75% of visits with BP <140/90 mmHg) and eGFR loss (i.e. a >30% reduction from baseline) or worsening of albuminuria status over time was assessed. Results: At baseline 33% of patients had aTRH. Over the 4-year follow-up, 20% had a >30% eGFR reduction. Patients with aTRH had an increased risk of eGFR loss >30% (OR 1.31; P<0.007). In patients with aTRH, BPC was associated with a 79% (P=0.029) greater risk of eGFR reduction despite a 58% (P=0.001) lower risk of albuminuria status worsening. In non-aTRH, no association was found between BPC and renal outcome. Conclusion: In patients with stage 3 CKD the presence of aTRH entails a faster loss of eGFR. More effective prevention of aTRH should be implemented as this condition is associated with a burden of risk not modifiable by tight BP reduction.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Apparent Treatment Resistant Hypertension, Blood Pressure Control and the Progression of Chronic Kidney Disease in Patients with Type 2 Diabetes

Viazzi

Greco

Ceriello

et al. 2018

Kidney Blood Press Res

View full text Add to dashboard Cite

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“…Hypertension is the major contributing risk factor for kidney disease, 1,2 stroke, 3 preterm birth, 4 heart failure, 5 and cardiovascular diseases. 6,7 It is also the most important preventable part cause of mortality 8,9 and morbidity.…”

Section: Introductionmentioning

confidence: 99%

Improving the Blood Pressure Control With the ProActive Attitude of Hypertensive Patients Seeking Follow-up Services

Tang

Bishwajit

et al. 2016

Medicine

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Proactive attitude of hypertensive patients seeking follow-up services (FUS) lies at the core of self-efficacy. However, few evidence have shown the activeness of seeking FUS in the context of blood pressure control among hypertensive patients. Improvements in follow-up visits may not just by services itself cause better control of blood pressure among hypertensive patients, rather due to the patient's pro-active attitude of the patient in seeking FUS.A cross-sectional study was carried out in selected rural regions of China to explore the association between blood pressure control and sociodemographic and economic variables and activeness of hypertensive patients in seeking FUS. The primary clinical outcome for this study was blood pressure control (systolic blood pressure <140 mmHg or diastolic blood pressure <90 mmHg)Out of the total 2321 participants with hypertension aged 35 years or older participated in this survey. Number of proactive FUS seekers were 3.17 times greater than those of passive seekers (odds ratio [OR] = 3.17, 95% confidence interval [CI] = 2.56–3.93, P < 0.001). In all subgroups, hypertensive patients who were seeking FUS actively were more likely to control blood pressure better than those seeking FUS passively.Proactive attitude of seeking follow-up services can improve blood pressure control among hypertensive patients.

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“…Most epidemiological studies, however, lack key elements (e.g. medication doses, adherence, and aetiology assessments are mostly lacking, while ABPM is scarcely used) to define true resistant hypertension' [19]. Unobtrusive and accurate wearable blood pressure (BP) measurement would thus be a great advantage for the management of hypertension, which is very well illustrated in a recent review -dedicated to management of hypertension in CKD -by Parati et al [39].…”

Section: Blood Pressure (6/23)mentioning

confidence: 99%

Wearable sensors: can they benefit patients with chronic kidney disease?

Wieringa

Broers

Kooman

et al. 2017

Expert Review of Medical Devices

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Introduction: This article ponders upon wearable medical measurement devices in relation to Chronic Kidney Disease (CKD) and its' associated comorbidities -and whether these might benefit CKD-patients. We aimed to map the intersection(s) of nephrology and wearable sensor technology to help technologists understand medical aspects, and clinicians to understand technological possibilities that are available (or soon will become so). Areas covered: A structured literature search on main comorbidities and complications CKD patients suffer from, was used to steer mini-reviews on wearable sensor technologies clustered around 3 themes being: Cardiovascular-related, diabetes-related and physical fitness/frailty. This review excludes wearable dialysis -although also strongly enabled by miniaturization -because that highly important theme deserves separate in-depth reviewing. Expert commentary: Continuous progress in integrated electronics miniaturization enormously lowered price, size, weight and energy consumption of electronic sensors, processing power, memory and wireless connectivity. These combined factors boost opportunities for wearable medical sensors. Such devices can be regarded as enablers for: Remote monitoring, influencing human behaviour (exercise, dietary), enhanced home care, remote consults, patient education and peer networks. However, to make wearable medical devices succeed, the challenge to fit them into health care structures will be dominant over the challenge to realize the bare technologies themselves. ARTICLE HISTORY

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The double challenge of resistant hypertension and chronic kidney disease

Cited by 151 publications

References 91 publications

Apparent Treatment Resistant Hypertension, Blood Pressure Control and the Progression of Chronic Kidney Disease in Patients with Type 2 Diabetes

Apparent Treatment Resistant Hypertension, Blood Pressure Control and the Progression of Chronic Kidney Disease in Patients with Type 2 Diabetes

Improving the Blood Pressure Control With the ProActive Attitude of Hypertensive Patients Seeking Follow-up Services

Wearable sensors: can they benefit patients with chronic kidney disease?

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