The double challenge of resistant hypertension and chronic kidney disease
Patrick Rossignol
(1, 2, 3)
,
Ziad Massy
(4, 5)
,
Michel Azizi
(6, 7)
,
George Bakris
(8)
,
Eberhard Ritz
(9)
,
Adrian Covic
(10)
,
David Goldsmith
(11)
,
Gunnar Heine
(12)
,
Kitty Jager
(13)
,
Mehmet Kanbay
(14)
,
Francesca Mallamaci
(15, 16)
,
Alberto Ortiz
(17, 18, 19, 20)
,
Raymond Vanholder
(21)
,
Andrzej Wiecek
(22)
,
Carmine Zoccali
(16)
,
Gérard Michel London
(23)
,
Benedicte Stengel
(5)
,
Denis Fouque
(24)
1
CIC -
Centre d'investigation clinique [Nancy]
2 DCAC - Défaillance Cardiovasculaire Aiguë et Chronique
3 ALTIR - Association Lorraine pour le Traitement de l'Insuffisance Rénale
4 Service Néphrologie/Dialyse [AP-HP Ambroise-Paré]
5 CESP - Centre de recherche en épidémiologie et santé des populations
6 HEGP - Hôpital Européen Georges Pompidou [APHP]
7 CIC 1418 - CIC - HEGP
8 The University of Chicago Medicine [Chicago]
9 Universität Heidelberg [Heidelberg]
10 Nephrology Clinic Dialysis and Renal Transplant Center, Iasi
11 Guy's and St Thomas' Hospitals
12 Universitätsklinikum des Saarlandes
13 AMC - Academic Medical Center - Academisch Medisch Centrum [Amsterdam]
14 Koc University, School of Medicine, Istanbul
15 Azienda Ospedaliera Ospedali Civili Riuniti
16 CNR-IFC Clinical Epidemiology and Pathophysiology of Renal Diseases and Hpertension Unit, Reggio Calabria
17 FJD - Fundacion Jimenez Diaz [Madrid]
18 UAM - Universidad Autónoma de Madrid
19 REDINREN Barcelona
20 IRSIN - Insituto Reina Sofia de Investigaciones Nefrológicas
21 Nephrology Section [Ghent]
22 SUM - Medical University of Silesia
23 PARCC - UMR-S U970 - Paris-Centre de Recherche Cardiovasculaire
24 Service de Néphrologie [Lyon]
2 DCAC - Défaillance Cardiovasculaire Aiguë et Chronique
3 ALTIR - Association Lorraine pour le Traitement de l'Insuffisance Rénale
4 Service Néphrologie/Dialyse [AP-HP Ambroise-Paré]
5 CESP - Centre de recherche en épidémiologie et santé des populations
6 HEGP - Hôpital Européen Georges Pompidou [APHP]
7 CIC 1418 - CIC - HEGP
8 The University of Chicago Medicine [Chicago]
9 Universität Heidelberg [Heidelberg]
10 Nephrology Clinic Dialysis and Renal Transplant Center, Iasi
11 Guy's and St Thomas' Hospitals
12 Universitätsklinikum des Saarlandes
13 AMC - Academic Medical Center - Academisch Medisch Centrum [Amsterdam]
14 Koc University, School of Medicine, Istanbul
15 Azienda Ospedaliera Ospedali Civili Riuniti
16 CNR-IFC Clinical Epidemiology and Pathophysiology of Renal Diseases and Hpertension Unit, Reggio Calabria
17 FJD - Fundacion Jimenez Diaz [Madrid]
18 UAM - Universidad Autónoma de Madrid
19 REDINREN Barcelona
20 IRSIN - Insituto Reina Sofia de Investigaciones Nefrológicas
21 Nephrology Section [Ghent]
22 SUM - Medical University of Silesia
23 PARCC - UMR-S U970 - Paris-Centre de Recherche Cardiovasculaire
24 Service de Néphrologie [Lyon]
Patrick Rossignol
- Function : Author
- PersonId : 755843
- ORCID : 0000-0001-8009-3873
Michel Azizi
- Function : Author
- PersonId : 882897
Mehmet Kanbay
- Function : Author
- PersonId : 791018
- ORCID : 0000-0002-1297-0675
Alberto Ortiz
- Function : Author
- PersonId : 776609
- ORCID : 0000-0002-9805-9523
Raymond Vanholder
- Function : Author
- PersonId : 768115
- ORCID : 0000-0003-2633-1636
Carmine Zoccali
- Function : Author
- PersonId : 776724
- ORCID : 0000-0002-6616-1996
- IdRef : 033425809
Denis Fouque
- Function : Author
- PersonId : 761251
- ORCID : 0000-0002-9707-7199
- IdRef : 068884958
Abstract
Resistant hypertension is defined as blood pressure above goal despite adherence to a combination of at least three optimally dosed antihypertensive medications, one of which is a diuretic. Chronic kidney disease is the most frequent of several patient factors or comorbidities associated with resistant hypertension. The prevalence of resistant hypertension is increased in patients with chronic kidney disease, while chronic kidney disease is associated with an impaired prognosis in patients with resistant hypertension. Recommended low-salt diet and triple antihypertensive drug regimens that include a diuretic, should be complemented by the sequential addition of other antihypertensive drugs. New therapeutic innovations for resistant hypertension, such as renal denervation and carotid barostimulation, are under investigation especially in patients with advanced chronic kidney disease. We discuss resistant hypertension in chronic kidney disease stages 3-5 (ie, patients with an estimated glomerular filtration rate below 60 mL/min per 1·73 m(2) and not on dialysis), in terms of worldwide epidemiology, outcomes, causes and pathophysiology, evidence-based treatment, and a call for action.