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Resistant Hypertension in Chronic Kidney Disease

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Core Concepts in Hypertension in Kidney Disease

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Abstract

Resistant hypertension, currently defined as inability to achieve adequate blood pressure (BP) control despite proper use of ≥3 antihypertensive medications including a diuretic, is a common disorder with an estimated prevalence of around 9–12 % in the general hypertensive population. Although chronic kidney disease (CKD) has long been considered as a major underlying cause of resistance to antihypertensive therapy, only recent epidemiological data indicate a prevalence of resistant hypertension of about 20–35 % among people with CKD. This higher burden of resistant hypertension in the CKD setting may be attributable to specific CKD-related factors, such as impaired handling of sodium balance by the kidney, excessive activation of the sympathetic nervous system, arterial stiffness, and endothelial dysfunction. Importantly, recent prospective observational studies have provided evidence suggesting that resistant hypertension is strongly associated with elevated risks for adverse cardiovascular outcomes and progression to end-stage-renal-disease both in the general hypertensive population and in CKD. Before making the diagnosis of resistant hypertension, common factors related to pseudo-resistance need to be excluded. Performing ambulatory BP monitoring in the diagnostic approach of a patient presenting with resistant hypertension is of particular value in an attempt to exclude the white-coat phenomenon, a common cause of pseudo-resistance among CKD individuals. This chapter discusses the prevalence, incidence, and prognostic significance of resistant hypertension and provides insights on the complex mechanistic background of this clinical entity in people with CKD.

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Authors and Affiliations

  1. AHEPA Hospital, Aristotle University of Thessaloniki, St. Kyriakidi 1, Thessaloniki, GR54006, Greece

    Panagiotis I. Georgianos MD, PhD

  2. Hippokration Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, Thessaloniki, GR54642, Greece

    Pantelis A. Sarafidis MD, MSc, PhD

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  1. Panagiotis I. Georgianos MD, PhD
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Correspondence to Pantelis A. Sarafidis MD, MSc, PhD .

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  1. Global and Continuing Education, Harvard Medical School, Boston, Massachusetts, USA

    Ajay K. Singh

  2. VA Medical Center, Indiana University School of Medicine, Indianapolis, Indiana, USA

    Rajiv Agarwal

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Georgianos, P.I., Sarafidis, P.A. (2016). Resistant Hypertension in Chronic Kidney Disease. In: Singh, A., Agarwal, R. (eds) Core Concepts in Hypertension in Kidney Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-6436-9_5

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