Long-term trajectory of renal dysfunction and related risk factors in patients with apparently treatment-resistant and non-resistant arterial hypertension

Figures & data

Figure 1. Flow chart of the study. ATRH: apparently treatment-resistant hypertension; eGFR: estimated glomerular filtration rate (Chronic Kidney Disease Epidemiology Collaboration formula 2021); NAH: non-resistant arterial hypertension.

Table 1. Baseline clinical characteristics, renal function and average blood pressure values throughout follow-up in patients in the ATRH and NAH groups.

	ATRH (n = 137)	NAH (n = 128)	p
Time between check-ups in months, median [IQR]	6.1 [3.6–11.5]	7.0 [4.4–12.4]	<0.001
Male sex (%)	80 (58.4)	67 (52.3)	NS
Age [year], mean ± SD	57.9 ± 11.0	51.6 ± 13.9	0.001
Height [cm], mean ± SD	173 ± 10	174 ± 9	NS
Weight [kg], mean ± SD	96 ± 21	88 ± 20	NS
BMI, mean ± SD	32.1 ± 5.9	28.9 ± 5.3	<0.001
Baseline creatinine [µmol/L], mean ± SD	92 ± 22	84 ± 18	NS
Baseline eGFR [mL/min/1.73 m^2], mean ± SD	77 ± 20	87 ± 17	0.006
Baseline ACR [mg/mmol], median, [IQR]	0.80 [0.45–2.66]	0.57 [0.34–0.99]	NS
SBP, clinic [mmHg], mean ± SD	139 ± 12	133 ± 12	<0.001
DBP, clinic [mmHg], mean ± SD	82 ± 10	83 ± 7	NS
ABPM performed, n (%)	131 (96)	99 (78)	<0.001
SBP, ABPM daytime [mmHg], mean ± SD	136 ± 10	135 ± 13	NS
DBP, ABPM daytime [mmHg], mean ± SD	79 ± 10	84 ± 11	0.006
SBP, ABPM night-time [mmHg], mean ± SD	125 ± 12	121 ± 13	NS
DBP, ABPM night-time [mmHg], mean ± SD	69 ± 8	72 ± 10	NS
SBP, ABPM 24 h [mmHg], mean ± SD	134 ± 11	131 ± 12	NS
DBP, ABPM 24 h [mmHg], mean ± SD	76 ± 9	80 ± 10	0.029
Secondary hypertension, n (%)	30 (21.9)	18 (14.1)	NS
Obstructive sleep apnoea, n (%)	29 (21.2)	14 (10.9)	NS
Diabetes mellitus, n (%)	53 (38.7)	10 (7.8)	<0.001
Atrial fibrillation/flutter, n (%)	31 (22.6)	21 (16.4)	NS
History of stroke, n (%)	21 (15.3)	11 (8.6)	NS
Heart failure with reduced ejection fraction, n (%)	5 (3.6)	1 (0.8)	NS
Ischaemic heart disease, n (%)	22 (16.1)	6 (4.7)	NS
History of myocardial infarction, n (%)	13 (9.5)	5 (3.9)	NS
Peripheral vascular disease, n (%)	5 (3.6)	2 (1.6)	NS
Manifest CV disease*, n (%)	27 (19.7)	8 (6.3)	0.038
History of pulmonary embolism, n (%)	3 (2.2)	1 (0.8)	NS
Contrast exposure (iodine/gadolinium), n (%)	118 (86.1)	79 (61.7)	<0.001
Renal denervation, n (%)	23 (16.8)	2 (1.6)	<0.001
Other kidney disease^†, n (%)	9 (6.6)	10 (7.8)	NS

ABPM: ambulatory monitoring of blood pressure; ATRH: apparently treatment-resistant hypertension; BMI: body mass index; CV: cardiovascular; DBP: diastolic blood pressure; eGFR: estimated glomerular filtration rate (CKD-EPI); SBP: systolic blood pressure; IQR: interquartile range (25th–75th percentile), NAH: non-resistant arterial hypertension; NS: not significant; SD: standard deviation

*Composite of: ischaemic heart disease, history of myocardial infarction or stroke and/or peripheral vascular disease.

^†History of urolithiasis (n = 4 ATRH; n = 5 NAH), unilateral nephrectomy due to malignant lesion (n = 2 ATRH; n = 3 NAH), partial nephrectomy of one kidney (n = 2 NAH), contrast-induced nephropathy (n = 1 in each group), multiple myeloma (n = 1 ATRH), mesangioproliferative glomerulonephritis (n = 1 ATRH) and tuberous sclerosis (n = 1 NAH).

Table 2. Medication of patients in the ATRH and NAH groups.

	ATRH (n = 137)	NAH (n = 128)	p
Number of antihypertensive drugs, mean ± SD	4.9 ± 1.0	2.0 ± 0.8	<0.001
ACEi, n (%)	49 (35.8)	49 (38.3)	NS
ARBs, n (%)	88 (64.2)	52 (40.6)	0.002
Calcium channel blockers, n (%)	107 (78.1)	50 (39.1)	<0.001
Beta-blockers, n (%)	113 (82.5)	50 (39.1)	<0.001
Diuretics, n (%)	134 (97.8)	57 (44.5)	<0.001
Potassium-sparing diuretics, n (%)	94 (68.6)	7 (5.5)	<0.001
Spironolactone, eplerenone, n (%)	63 (46.0)	7 (5.5)	<0.001
Amiloride, n (%)	31 (22.6)	0 (0.0)	<0.001
Loop-acting diuretics, n (%)	14 (10.2)	3 (2.3)	NS
Thiazide and thiazide-like diuretics, n (%)	130 (94.8)	50 (39.1)	<0.001
Indapamide, n (%)	54 (39.4)	30 (23.4)	0.029
Hydrochlorothiazide, chlorthalidone, n (%)	76 (55.5)	20 (15.6)	<0.001
Alpha-blockers, n (%)	45 (32.8)	1 (0.8)	<0.001
Centrally acting antihypertensives, n (%)	16 (11.7)	5 (3.9)	NS
Statins, n (%)	90 (65.7)	40 (31.3)	<0.001
Fibrates, n (%)	7 (5.1)	0 (0.0)	NS
Ezetimibe, n (%)	6 (4.4)	2 (1.6)	NS
Insulin, n (%)	17 (12.4)	1 (0.8)	0.001
Metformin, n (%)	31 (22.6)	4 (3.1)	<0.001
Sulfonylurea derivates, n (%)	11 (8.0)	2 (1.6)	NS
DPP-4 inhibitors, n (%)	11 (8.0)	2 (1.6)	NS
SGLT2 inhibitors, n (%)	4 (2.9)	0 (0.0)	NS
GLP-1 agonists, n (%)	1 (0.7)	0 (0.0)	NS
Thiazolidinediones, n (%)	1 (0.7)	0 (0.0)	NS

ACEi: angiotensin-converting-enzyme inhibitor; ARB: angiotensin II receptor blocker; ATRH: apparently treatment-resistant hypertension; DPP-4: dipeptidyl peptidase-4; GLP-1: glucagon-like peptide-1; NAH: non-resistant arterial hypertension; NS: not significant; SD: standard deviation; SGLT2: sodium-glucose cotransporter-2

Figure 2. Development of serum creatinine during follow-up.

Figure 3. Development of estimated glomerular filtration rate (eGFR and CKD-EPI) during follow-up. CKD-EPI: Chronic Kidney Disease Epidemiology Collaboration formula 2021.

Figure 4. Trajectory of serum creatinine levels (A) and estimated glomerular filtration rate (B) after age and diabetes adjustment during follow-up: linear mixed-effect model analysis. eGFR: estimated glomerular filtration rate (Chronic Kidney Disease Epidemiology Collaboration formula 2021).