Treatment-resistant hypertension is associated with an increased risk for end-stage renal disease (ESRD), according to the findings of a prospective, population-based study.

Researchers led by Paul Muntner, PhD, of the University of Alabama at Birmingham, identified the association when they analyzed data from 9,974 participants in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study. During a median follow-up of 6.4 years, 152 cases of ESRD developed: 110 among the 2,147 subjects with treatment-resistant hypertension and 42 cases among the 7,827 subjects without treatment-resistant hypertension. After adjusting for multiple potential confounding factors, subjects who had treatment-resistant hypertension experienced a greater than sixfold increased risk for ESRD compared with those who did not have the condition, Dr. Muntner’s group reported online ahead of print in the American Journal of Kidney Diseases.

“The findings of the present study emphasize the need for appropriate clinical management strategies to lower BP in individuals with treatment-resistant hypertension,” the authors wrote.

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The REGARDS Study enrolled a population-based sample of black and white U.S. adults aged 45 years and older. The investigators defined treatment-resistant hypertension as uncontrolled blood pressure (BP) with concurrent use of three antihypertensive medication classes, including a diuretic, or the use of four or more antihypertensive medication classes, including a diuretic regardless of BP level. They defined uncontrolled BP as a systolic BP of 140 mm Hg or higher and/or diastolic BP of 90 mm Hg or higher, except for patients with an albumin-creatinine ratio of 30 mg/g or higher. For these patients, the researchers defined uncontrolled BP as a systolic BP of 130 mm Hg or higher and/or diastolic BP of 80 mm Hg or higher.