Song Su-Hyun, Kim Young-Jin, Choi Hong-Sang, Kim Chang-Seong, Bae Eun-Hui, Ahn Curie, Oh Kook-Hwan, Park Sue-Kyung, Lee Kyu-Beck, Sung Suah, Han Seung-Hyeok, Ma Seong-Kwon, Kim Soo-Wan
Department of Internal Medicine, Chonnam National University Medical School, Gwangju 61469, Korea.
Chonnam National Universitiy Hospital, Gwangju 61469, Korea.
J Clin Med. 2021 Sep 3;10(17):3998. doi: 10.3390/jcm10173998.
Apparent treatment-resistant hypertension (ATRH) is closely related to chronic kidney disease (CKD); however, the long-term outcomes and the effects of improvement in ATRH in patients with CKD are not well understood. We evaluated the relationship between the persistence of ATRH and the progression of CKD. This cohort study enrolled 1921 patients with CKD. ATRH was defined as blood pressure above 140/90 mmHg and intake of three different types of antihypertensive agents, including diuretics, or intake of four or more different types of antihypertensive agents, regardless of blood pressure. We defined ATRH subgroups according to the ATRH status at the index year and two years later. The prevalence of ATRH at baseline was 14.0%. The presence of ATRH at both time points was an independent risk factor for end-point renal outcome (HR, 1.41; 95% CI, 1.04-1.92; = 0.027). On the other hand, the presence of ATRH at any one of the time points was not statistically significant. In conclusion, persistent ATRH is more important for the prognosis of renal disease than the initial ATRH status. Continuous follow-up and appropriate treatment are important to improve the renal outcomes.
表观治疗抵抗性高血压（ATRH）与慢性肾脏病（CKD）密切相关；然而，CKD患者中ATRH的长期预后及改善效果尚不清楚。我们评估了ATRH的持续存在与CKD进展之间的关系。这项队列研究纳入了1921例CKD患者。ATRH定义为血压高于140/90 mmHg且服用包括利尿剂在内的三种不同类型的抗高血压药物，或服用四种或更多不同类型的抗高血压药物，无论血压情况如何。我们根据索引年份和两年后的ATRH状态定义了ATRH亚组。基线时ATRH的患病率为14.0%。两个时间点均存在ATRH是终点肾脏结局的独立危险因素（HR，1.41；95%CI，1.04 - 1.92；P = 0.027）。另一方面，在任何一个时间点存在ATRH在统计学上均无显著意义。总之，持续性ATRH对肾脏疾病预后的影响比初始ATRH状态更重要。持续随访和适当治疗对于改善肾脏结局很重要。
