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Abstract P2070: Renal, Cardiovascular, And Mortality Impacts Of Refractory Hypertension In Patients With Chronic Kidney Disease: Insights From The Chronic Renal Insufficiency Cohort (CRIC).


 Background:
 Refractory hypertension can be defined as uncontrolled blood pressure (BP at or above 140/90 mmHg) when taking five or more classes of antihypertensive medication, including a diuretic for patients with chronic kidney disease. The prognosis for patients with refractory hypertension is not understood.
 
 
 Methods:
 Refractory hypertension was assessed in the Chronic Renal Insufficiency Cohort (CRIC). A total of 3314 treated hypertensive patients were included, and patients were assigned a hypertensive phenotype (i.e., refractory hypertension, apparent treatment resistant hypertension [aTRH], hypertension) based on their baseline visit. Cox proportional hazards models were used to analyze differences in outcome risk across hypertensive phenotypes after controlling for age, race, diabetes, smoking, BMI, urine protein, eGFR, systolic blood pressure, education, and study site.
 
 
 Results:
 Refractory hypertension was found in 4.5% (149/3314) of treated hypertensive patients. When compared with those with aTRH, patients with refractory hypertension were significantly more likely to experience renal events - composite of end-stage renal disease and/or 50% drop in eGFR (hazard ratio [95% confidence interval], 1.64 [1.29, 2.09]); and cardiovascular events - composite of myocardial infarction, stroke, peripheral arterial disease, and congestive heart failure (1.34 [1.04, 1.73]); but showed no significant difference in all-cause mortality risk (1.06 [0.80, 1.41]).
 
 
 Conclusions:
 Refractory hypertension increases the risk for renal and cardiovascular disease over that previously observed for aTRH in patients with chronic kidney disease.
