Abstract: FR-PO570

Inflammation and Apparent Treatment Resistant Hypertension in Patients with CKD – The Results from the CRIC Study

Session Information

Category: Hypertension

  • 1106 Hypertension: Clinical and Translational - Secondary Causes

Authors

  • Chen, Jing, Tulane School of Medicine, New Orleans, Louisiana, United States
  • Chen, Hsiang-Yu, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Xie, Dawei, University of Pennsylvania School of Medicine Center for Clinical Epidemiology and Biostatistics, Philadelphia, Pennsylvania, United States
  • Rao, Panduranga S., University of Michigan Health System, Ann Arbor, Michigan, United States
  • Weir, Matthew R., University of Maryland School of Medicine , Baltimore, Maryland, United States
  • Wright, Jackson T., Case Western Research University, Cleveland, Ohio, United States
  • Rahman, Mahboob, Case Western Reserve University, Cleveland, Ohio, United States
  • He, Jiang, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • Bundy, Joshua David, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • Hamm, L. Lee, Tulane University School of Medicine, New Orleans, Louisiana, United States
  • Hsu, Chi-yuan, University of California San Francisco, San Francisco, California, United States
  • Lash, James P., University of Illinois at Chicago, Chicago, Illinois, United States
  • Miller, Edgar R., Johns Hopkins University, Baltimore, Maryland, United States
  • Thomas, George, Cleveland Clinic, CLEVELAND, Ohio, United States
  • Cohen, Debbie L., University of Pennsylvania School of Medicine , Philadelphia, Pennsylvania, United States
  • Raj, Dominic S., GWU Medical Faculty Associates, Washington, District of Columbia, United States
Background

Apparent treatment resistant hypertension (ATRH) is highly prevalent and associated with increased risk of cardiovascular disease (CVD) in patients with chronic kidney disease (CKD). Inflammation may be associated with blood pressure and is increased in CKD patients. It is unknown if inflammation is associated with increased likelihood of ATRH in CKD.

Methods

ATRH is defined as systolic blood pressure (SBP) ≥140 mmHg or diastolic BP (DBP) ≥90 mmHg while taking ≥ 3 antihypertensive medications or taking ≥ 4 antihypertensive medications with SBP <140 mmHg and DBP <90 mmHg. 1359 Chronic Renal Insufficiency Cohort (CRIC) Study participants with ATRH and 2008 participants without ATRH, but with hypertension at the baseline visit, were included in this analysis. Multiple logistic regression models were adjusted for age, sex, race, clinical sites, diabetes, alcohol consumption, body mass index, physical activity, estimated glomerular filtration rate, 24-hour urinary protein, and 24-hour urinary sodium.

Results

Multiple-adjusted odds ratios (95% confidence intervals) of ATRH for the highest tertile comparing to the lowest tertile of the inflammatory biomarker levels were 1.31 (1.06-1.62, p=0.026) for tumor necrosis factor-α (TNF-α) and 0.75 (0.61-0.92, p= 0.008) for transforming growth factor beta (TGF-β). In addition, multiple-adjusted odds ratios (95% confidence intervals) associated with one standard deviation difference in log-transformed TGF-β was 0.90 (0.83-0.98, p= 0.013). The levels of interleukin-6, interleukin-1 beta, and C-reactive protein were not significantly associated with odds of ATRH.

Conclusion

Higher levels of TNF-α and lower levels of TGF-β (as anti-inflammatory biomarker) were independently associated with odds of ATRH. Further study is warranted to investigate if targeting specific inflammatory pathways may improve blood pressure control among patients with CKD.

Funding

  • NIDDK Support