Abstract: TH-PO686
Apparent Treatment-Resistant Hypertension (ATRH) Stratified by Ambulatory Blood Pressure Monitoring (ABPM) in CKD: A Report from the Chronic Renal Insufficiency Cohort (CRIC) Study
Session Information
- Hypertension and CVD: Epidemiology, Risk Factors
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention
Authors
- Felts, Jesse, University Hospitals Cleveland Medical Center, University Heights, Ohio, United States
- Thomas, George, Cleveland Clinic, Cleveland, Ohio, United States
- Brecklin, Carolyn S., University of Illinois, Chicago, Illinois, United States
- Chen, Jing, Tulane School of Medicine, New Orleans, Louisiana, United States
- Drawz, Paul E., University of Minnesota, Minneapolis, Minnesota, United States
- Lustigova, Eva, Kaiser Permanente Medical Group, Pasadena, California, United States
- Mehta, Rupal, Northwestern Univesrsity, Feinberg School of Medicine, Chicago, Illinois, United States
- Miller, Edgar R., Johns Hopkins University, Baltimore, Maryland, United States
- Sozio, Stephen M., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Weir, Matthew R., University of Maryland School of Medicine, Baltimore, Maryland, United States
- Xie, Dawei, University of Pennsylvania School of Medicine Center for Clinical Epidemiology and Biostatistics, Philadelphia, Pennsylvania, United States
- Wang, Xue, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Rahman, Mahboob, Case Western Reserve University, Cleveland, Ohio, United States
Group or Team Name
- for the CRIC study investigators
Background
ATRH defined using office blood pressure (BP) measurements, is common in patients with chronic kidney disease. Whether measurement of 24 hour ABPM is of value in risk stratification in patients with ATRH is unclear.
Methods
We analyzed data from the CRIC study, a prospective study of participants with chronic kidney disease. Office BP was measured by trained staff; 24 hour ABPM was measured using Spacelabs monitors. ATRH was defined as mean office systolic BP ≥ 140 mm Hg or diastolic BP ≥ 90 mm Hg on ≥ 3 antihypertensive medications, average ABPM daytime systolic BP ≥ 135 mm Hg or diastolic BP ≥ 85 mm Hg on ≥ 3 antihypertensive medications, or the use of > 3 antihypertensive medications. Outcomes were composite cardiovascular disease (CVD)(myocardial infarction, stroke, peripheral arterial disease, heart failure), renal outcomes (end stage renal disease or 50% decline in GFR), and groups were compared using Cox regression analyses.
Results
Of 475 participants with ATRH based on office BP, 40 participants (8%) had controlled ABPM consistent with white coat hypertension. ATRH based on office and ABPM criteria (ABPM-ATRH) was seen in 162 (34%), and 273 (54%) of participants had ATRH based on the use of > three antihypertensive medications. The control group was participants with BP controlled by office and ABPM criteria (n=711). While unadjusted event rates of composite CVD (8.19 vs 2.77 per 100 patient years) renal outcomes (12.75 vs 2.97 per 100 patient years), and mortality (4.93 vs 2.18 per 100 patient years) were higher, in adjusted analyses, the risk of composite CVD (Hazard ratio (HR) 1.27, 95% confidence intervals (CI) 0.59, 2.7), renal outcomes (HR 1.68 95% CI 0.88, 3.21), and mortality (HR 1.27 95% CI 0.5, 3.25) was not statistically significantly higher in participants with ABPM-ATRH group compared to the participants with controlled BP.
Conclusion
In our study population with chronic kidney disease, most patients with ATRH defined based on office BP have ATRH confirmed by ABPM. While ABPM defined ATRH was not an independent risk factor for outcomes, the presence of ABPM-TRH identified participants at high risk for clinical outcomes
Funding
- NIDDK Support