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Kidney Function Decline and Apparent Treatment-Resistant Hypertension in the Elderly
BACKGROUND: Cross-sectional studies show a strong association between chronic kidney disease and apparent treatment-resistant hypertension, but the longitudinal association of the rate of kidney function decline with the risk of resistant hypertension is unknown. METHODS: The population-based Three-...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4726557/ https://www.ncbi.nlm.nih.gov/pubmed/26807712 http://dx.doi.org/10.1371/journal.pone.0146056 |
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author | Kaboré, Jean Metzger, Marie Helmer, Catherine Berr, Claudine Tzourio, Christophe Massy, Ziad A. Stengel, Bénédicte |
author_facet | Kaboré, Jean Metzger, Marie Helmer, Catherine Berr, Claudine Tzourio, Christophe Massy, Ziad A. Stengel, Bénédicte |
author_sort | Kaboré, Jean |
collection | PubMed |
description | BACKGROUND: Cross-sectional studies show a strong association between chronic kidney disease and apparent treatment-resistant hypertension, but the longitudinal association of the rate of kidney function decline with the risk of resistant hypertension is unknown. METHODS: The population-based Three-City included 8,695 participants older than 65 years, 4265 of them treated for hypertension. We estimated the odds ratios (OR) of new-onset apparent treatment-resistant hypertension, defined as blood pressure ≥ 140/90 mmHg despite use of 3 antihypertensive drug classes or ≥ 4 classes regardless of blood pressure, associated with the mean estimated glomerular filtration rate (eGFR) level and its rate of decline over 4 years, compared with both controlled hypertension and uncontrolled nonresistant hypertension with ≤ 2 drugs. GFR was estimated with three different equations. RESULTS: Baseline prevalence of apparent treatment-resistant hypertension and of controlled and uncontrolled nonresistant hypertension, were 6.5%, 62.3% and 31.2%, respectively. During follow-up, 162 participants developed apparent treatment-resistant hypertension. Mean eGFR decline with the MDRD equation was 1.5±2.9 mL/min/1.73 m² per year: 27.7% of the participants had an eGFR ≥3 and 10.1% ≥ 5 mL/min/1.73 m² per year. After adjusting for age, sex, obesity, diabetes, and cardiovascular history, the ORs for new-onset apparent treatment-resistant hypertension associated with a mean eGFR level, per 15 mL/min/1.73m² drop, were 1.23 [95% confidence interval 0.91–1.64] compared to controlled hypertension and 1.10 [0.83–1.45] compared to uncontrolled nonresistant hypertension; ORs associated with a decline rate ≥ 3 mL/min/1.73m² per year were 1.89 [1.09–3.29] and 1.99 [1.19–3.35], respectively. Similar results were obtained when we estimated GFR with the CKDEPI and the BIS1 equations. ORs tended to be higher for an eGFR decline rate ≥ 5 mL/min/1.73m² per year. CONCLUSION: The speed of kidney function decline is associated more strongly than kidney function itself with the risk of apparent treatment-resistant hypertension in the elderly. |
format | Online Article Text |
id | pubmed-4726557 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-47265572016-02-03 Kidney Function Decline and Apparent Treatment-Resistant Hypertension in the Elderly Kaboré, Jean Metzger, Marie Helmer, Catherine Berr, Claudine Tzourio, Christophe Massy, Ziad A. Stengel, Bénédicte PLoS One Research Article BACKGROUND: Cross-sectional studies show a strong association between chronic kidney disease and apparent treatment-resistant hypertension, but the longitudinal association of the rate of kidney function decline with the risk of resistant hypertension is unknown. METHODS: The population-based Three-City included 8,695 participants older than 65 years, 4265 of them treated for hypertension. We estimated the odds ratios (OR) of new-onset apparent treatment-resistant hypertension, defined as blood pressure ≥ 140/90 mmHg despite use of 3 antihypertensive drug classes or ≥ 4 classes regardless of blood pressure, associated with the mean estimated glomerular filtration rate (eGFR) level and its rate of decline over 4 years, compared with both controlled hypertension and uncontrolled nonresistant hypertension with ≤ 2 drugs. GFR was estimated with three different equations. RESULTS: Baseline prevalence of apparent treatment-resistant hypertension and of controlled and uncontrolled nonresistant hypertension, were 6.5%, 62.3% and 31.2%, respectively. During follow-up, 162 participants developed apparent treatment-resistant hypertension. Mean eGFR decline with the MDRD equation was 1.5±2.9 mL/min/1.73 m² per year: 27.7% of the participants had an eGFR ≥3 and 10.1% ≥ 5 mL/min/1.73 m² per year. After adjusting for age, sex, obesity, diabetes, and cardiovascular history, the ORs for new-onset apparent treatment-resistant hypertension associated with a mean eGFR level, per 15 mL/min/1.73m² drop, were 1.23 [95% confidence interval 0.91–1.64] compared to controlled hypertension and 1.10 [0.83–1.45] compared to uncontrolled nonresistant hypertension; ORs associated with a decline rate ≥ 3 mL/min/1.73m² per year were 1.89 [1.09–3.29] and 1.99 [1.19–3.35], respectively. Similar results were obtained when we estimated GFR with the CKDEPI and the BIS1 equations. ORs tended to be higher for an eGFR decline rate ≥ 5 mL/min/1.73m² per year. CONCLUSION: The speed of kidney function decline is associated more strongly than kidney function itself with the risk of apparent treatment-resistant hypertension in the elderly. Public Library of Science 2016-01-25 /pmc/articles/PMC4726557/ /pubmed/26807712 http://dx.doi.org/10.1371/journal.pone.0146056 Text en © 2016 Kaboré et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Kaboré, Jean Metzger, Marie Helmer, Catherine Berr, Claudine Tzourio, Christophe Massy, Ziad A. Stengel, Bénédicte Kidney Function Decline and Apparent Treatment-Resistant Hypertension in the Elderly |
title | Kidney Function Decline and Apparent Treatment-Resistant Hypertension in the Elderly |
title_full | Kidney Function Decline and Apparent Treatment-Resistant Hypertension in the Elderly |
title_fullStr | Kidney Function Decline and Apparent Treatment-Resistant Hypertension in the Elderly |
title_full_unstemmed | Kidney Function Decline and Apparent Treatment-Resistant Hypertension in the Elderly |
title_short | Kidney Function Decline and Apparent Treatment-Resistant Hypertension in the Elderly |
title_sort | kidney function decline and apparent treatment-resistant hypertension in the elderly |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4726557/ https://www.ncbi.nlm.nih.gov/pubmed/26807712 http://dx.doi.org/10.1371/journal.pone.0146056 |
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