Long-term trajectory of renal dysfunction and related risk factors in patients with apparently treatment-resistant and non-resistant arterial hypertension
Creators: name: Ramík, Zdeněk
name: Václavík, Jan
name: Kvapil, Tomáš
name: Jelínek, Libor
name: Kociánová, Eva
name: Kamasová, Monika
name: Benešová, Klára
name: Jarkovský, Jiří
name: Drápela, Martin
name: Lys, Zdeněk
Publisher: name: Taylor & Francis
Year: 2024
Subjects: subject: Medicine
subject: Biotechnology
subject: Immunology
subject: FOS: Clinical medicine
subject: Mathematical Sciences not elsewhere classified
subject: Marine Biology
subject: Cancer
subject: Hematology
subject: Computational Biology

description: <b>Objectives:</b> Evidence suggests that renal function increasingly deteriorates in patients with apparently treatment-resistant hypertension (ATRH) in comparison with those who have non-resistant arterial hypertension (NAH). We aimed to assess the long-term decline in renal function between these patient groups and identify specific risk factors contributing to the progression of renal dysfunction. <b>Methods:</b> Data for 265 patients with ATRH and NAH in a hypertension excellence centre were retrospectively evaluated. Demographic characteristics, co-morbidities, laboratory findings, secondary causes of hypertension, medication and exposure to contrast agents were assessed. To address differences between groups, adjustment with linear mixed-effect models was used. <b>Results:</b> Data from the first 4 years of follow-up were evaluated. After adjustment for age and diabetes, which were identified as independent risk factors for renal dysfunction progression in the study cohort, the mean decrease in estimated glomerular filtration rate per year was steeper with ATRH than with NAH (−1.49 <i>vs.</i> −0.65 mL/min/1.73 m<sup>2</sup> per year; difference in slope, 0.83 mL/min/1.73 m<sup>2</sup> per year; 95% confidence interval [CI]: 0.25–1.41, <i>p</i> = 0.005). In subgroup analyses, without Holm–Bonferroni correction, the prescription of MRA indicated a faster decline in renal function in ATRH. Following correction, no specific therapeutic risk factor was associated with faster progression of renal dysfunction. <b>Conclusions:</b> Renal function declines twice as fast with ATRH compared with NAH, independently of age and diabetes. Larger studies are needed to reveal risk factors for renal dysfunction in patients with hypertension. High blood pressure (arterial hypertension) is a significant risk factor for kidney function decline. Resistant hypertension represents a subtype of hypertension that is difficult to treat and requires multiple antihypertensive agents to achieve effective blood pressure control. Recent research suggests that individuals with resistant hypertension are at greater risk of kidney dysfunction. This study analyses data from adult patients with arterial hypertension and resistant hypertension followed-up for a mean duration of 6.4 years. A faster decline in kidney function was observed in patients with resistant hypertension. This suggests that renal function in these patients should be closely monitored. After statistical evaluation, no medication was found to be associated with an increased risk of kidney failure progression. However, two specific medications, spironolactone and eplerenone, raised suspicion and require further exploration in larger prospective studies.