The double challenge of resistant hypertension and chronic kidney disease.

Abstract

Resistant hypertension is defined as blood pressure above goal despite adherence to a combination of at least three optimally dosed antihypertensive medications, one of which is a diuretic. Chronic kidney disease is the most frequent of several patient factors or comorbidities associated with resistant hypertension. The prevalence of resistant hypertension is increased in patients with chronic kidney disease, while chronic kidney disease is associated with an impaired prognosis in patients with resistant hypertension. Recommended low-salt diet and triple antihypertensive drug regimens that include a diuretic, should be complemented by the sequential addition of other antihypertensive drugs. New therapeutic innovations for resistant hypertension, such as renal denervation and carotid barostimulation, are under investigation especially in patients with advanced chronic kidney disease. We discuss resistant hypertension in chronic kidney disease stages 3-5 (ie, patients with an estimated glomerular filtration rate below 60 mL/min per 1·73 m(2) and not on dialysis), in terms of worldwide epidemiology, outcomes, causes and pathophysiology, evidence-based treatment, and a call for action.

• Authors: Patrick Rossignol, Ziad A Massy, Michel Azizi, George Bakris, Eberhard Ritz, Adrian Covic, David Goldsmith, Gunnar H Heine, Kitty J Jager, Mehmet Kanbay, Francesca Mallamaci, Alberto Ortiz, Raymond Vanholder, Andrzej Wiecek, Carmine Zoccali, Gérard Michel London, Bénédicte Stengel, Denis Fouque, ERA-EDTA EURECA-m working group, Red de Investigación Renal (REDINREN) network, Cardiovascular and Renal Clinical Trialists (F-CRIN INI-CRCT) network
• Journal: Lancet (London, England) (Lancet) Vol. 386 Issue 10003 Pg. 1588-98 (Oct 17 2015) ISSN: 1474-547X [Electronic] England
• PMID: 26530623 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2015 Elsevier Ltd. All rights reserved.

Chemical References

• Antihypertensive Agents
• Diuretics

Topics

• Antihypertensive Agents (therapeutic use)
• Blood Pressure
• Diet, Sodium-Restricted
• Diuretics (therapeutic use)
• Humans
• Hypertension (complications, epidemiology, physiopathology, therapy)
• Renal Insufficiency, Chronic (complications, epidemiology)
• Risk Factors
• Treatment Outcome