University of Chicago Medicine, Chicago, Illinois, USA.
Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA.
Am J Hypertens. 2024 May 15;37(6):438-446. doi: 10.1093/ajh/hpae020.
Chronic kidney disease (CKD) is a common comorbidity in patients with apparent treatment-resistant hypertension (aTRH). We assessed clinical outcomes, healthcare resource utilization events, and costs in patients with aTRH or difficult-to-control hypertension and stage 3-4 CKD with uncontrolled vs. controlled BP.
This retrospective cohort study used linked IQVIA Ambulatory EMR-US and IQVIA PharMetrics Plus claims databases. Adult patients had claims for ≥3 antihypertensive medication classes within 30 days between 01/01/2015 and 06/30/2021, 2 office BP measures recorded 1-90 days apart, ≥1 claim with ICD-9/10-CM diagnosis codes for CKD 3/4, and ≥1 year of continuous enrollment. Baseline BP was defined as uncontrolled (≥130/80 mm Hg) or controlled (<130/80 mm Hg) BP. Outcomes included risk of major adverse cardiovascular events plus (MACE+; stroke, myocardial infarction, heart failure hospitalization), end-stage renal disease (ESRD), healthcare resource utilization events, and costs during follow-up.
Of 3,966 patients with stage 3-4 CKD using ≥3 antihypertensive medications, 2,479 had uncontrolled BP and 1,487 had controlled BP. After adjusting for baseline differences, patients with uncontrolled vs. controlled BP had a higher risk of MACE+ (HR [95% CI]: 1.18 [1.03-1.36]), ESRD (1.85 [1.44-2.39]), inpatient hospitalization (rate ratio [95% CI]: 1.35 [1.28-1.43]), and outpatient visits (1.12 [1.11-1.12]) and incurred higher total medical and pharmacy costs (mean difference [95% CI]: $10,055 [$6,741-$13,646] per patient per year).
Patients with aTRH and stage 3-4 CKD and uncontrolled BP despite treatment with ≥3 antihypertensive classes had an increased risk of MACE+ and ESRD and incurred greater healthcare resource utilization and medical expenditures compared with patients taking ≥3 antihypertensive classes with controlled BP.
慢性肾脏病（CKD）是明显治疗抵抗性高血压（aTRH）患者的常见合并症。我们评估了伴有未控制 vs. 控制血压的治疗抵抗性高血压或难以控制的高血压以及 3-4 期 CKD 患者的临床结局、医疗资源利用事件和成本。
本回顾性队列研究使用了 IQVIA 门诊电子病历-US 和 IQVIA PharMetrics Plus 索赔数据库。成人患者在 2015 年 1 月 1 日至 2021 年 6 月 30 日期间的 30 天内至少有 3 种降压药物类别的索赔，2 次间隔 1-90 天的门诊血压测量，至少有 1 次 ICD-9/10-CM 编码为 CKD 3/4 的诊断，且至少有 1 年的连续参保。基线血压定义为未控制（≥130/80mmHg）或控制（＜130/80mmHg）血压。研究结果包括主要不良心血管事件加（MACE+；中风、心肌梗死、心力衰竭住院）、终末期肾病（ESRD）、随访期间的医疗资源利用事件和成本。
在使用≥3 种降压药物的 3966 名 3-4 期 CKD 患者中，2479 名患者的血压未得到控制，1487 名患者的血压得到了控制。调整基线差异后，与血压控制患者相比，血压未控制患者发生 MACE+的风险更高（HR[95%CI]：1.18[1.03-1.36]）、ESRD（1.85[1.44-2.39]）、住院治疗（住院率比[95%CI]：1.35[1.28-1.43]）和门诊就诊（1.12[1.11-1.12]），且总医疗和药物费用更高（每位患者每年的平均差异[95%CI]：10055 美元[6741-13646]）。
尽管接受了≥3 种降压药物治疗，但仍存在治疗抵抗性高血压和 3-4 期 CKD 且血压未得到控制的患者发生 MACE+和 ESRD 的风险增加，且与使用≥3 种降压药物控制血压的患者相比，发生的医疗资源利用和医疗支出更多。
