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Abstract: TH-OR107

Resistant Hypertension Potentiates the Risk of ESRD in African Americans in the Million Veteran Program (MVP)

Session Information

Category: Hypertension and CVD

  • 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention


  • Akwo, Elvis A., Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Robinson-Cohen, Cassianne, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Wilson, Peter W., Emory University, Atlanta, Georgia, United States
  • O'Donnell, Christopher Joseph, Boston Veterans Administration, Boston, Massachusetts, United States
  • Edwards, Todd L., Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Hung, Adriana, VA & Vanderbilt University, Nashville, Tennessee, United States

African Americans (AAs) are 4 times as likely as Whites to develop ESRD. Resistant hypertension (RH), a severe form of hypertension (HTN) is associated with increased risk of cardiovascular (CV) and renal outcomes. We investigated how ESRD risk is modified by race.


We designed a retrospective cohort of 240,038 veterans with HTN, enrolled in the MVP with a GFR >30 ml/min. The primary exposure was incident RH (time-varying). The primary outcome was incident ESRD during a 13.5 yr follow up: 2004-2017. Secondary outcomes were myocardial infarction (MI), stroke, and death. Incident RH was defined as failure to achieve outpatient BP <140/90 mmHg with 3 anti-HTN drugs, including a thiazide, or use of ≥4 drugs, excluding BPs when pain score was >5, when interfering medications or secondary HTN were present. Poisson models were used to estimate incidence rates (IR) and test biologic interaction with race. Cox (and competing-risks) models were used to identify independent effects.


Median age was 60 yrs; 20% were African American and 6% were women with 23,385 incident RH cases (9.7%). RH patients had higher IR (per 1000 PY) of ESRD (4.5 vs. 1.3), MI (6.5 vs 3), stroke (16.4 vs 7.6) and death (12 vs 6.9) than non-resistant HTN (NRH). In Cox models adjusted for traditional CV risk factors; RH patients had a 2.0, 1.67, 1.9 and 1.14-fold higher risk of ESRD, MI, stroke, and death, respectively. In Poisson models, AAs with RH had a 2.5-fold higher risk of ESRD compared to AAs with NRH; 3-fold the risk of Whites with RH, and 9-fold the risk of Whites with NRH [p-interaction < 0.01].


RH was associated with a higher risk of ESRD (and CV outcomes), especially in AAs. Interventions (behavioral, drug choices) that improve reaching BP targets in RH patients, could have a major impact on ESRD incidence in this high-risk population, particularly in AAs.


  • Veterans Affairs Support