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Apparent treatment-resistant hypertension and chronic kidney disease: another cardiovascular-renal syndrome?

Publication ,  Journal Article
Vemulapalli, S; Tyson, CC; Svetkey, LP
Published in: Adv Chronic Kidney Dis
November 2014

To identify patients at increased risk of cardiovascular (CV) outcomes, apparent treatment-resistant hypertension (aTRH) is defined as having a blood pressure above goal despite the use of 3 or more antihypertensive therapies of different classes at maximally tolerated doses, ideally including a diuretic. Recent epidemiologic studies in selected populations estimated the prevalence of aTRH as 10% to 15% among patients with hypertension and that aTRH is associated with elevated risk of CV and renal outcomes. Additionally, aTRH and CKD are associated. Although the pathogenesis of aTRH is multifactorial, the kidney is believed to play a significant role. Increased volume expansion, aldosterone concentration, mineralocorticoid receptor activity, arterial stiffness, and sympathetic nervous system activity are central to the pathogenesis of aTRH and are targets of therapies. Although diuretics form the basis of therapy in aTRH, pathophysiologic and clinical data suggest an important role for aldosterone antagonism. Interventional techniques, such as renal denervation and carotid baroreceptor activation, modulate the sympathetic nervous system and are currently in phase III trials for the treatment of aTRH. These technologies are as yet unproven and have not been investigated in relationship to CV outcomes or in patients with CKD.

Duke Scholars

Published In

Adv Chronic Kidney Dis

DOI

EISSN

1548-5609

Publication Date

November 2014

Volume

21

Issue

6

Start / End Page

489 / 499

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Sympathetic Nervous System
  • Sympathectomy
  • Renin-Angiotensin System
  • Renal Insufficiency, Chronic
  • Receptors, Mineralocorticoid
  • Pressoreceptors
  • Hypertension
  • Humans
  • Electric Stimulation Therapy
 

Citation

APA
Chicago
ICMJE
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Vemulapalli, S., Tyson, C. C., & Svetkey, L. P. (2014). Apparent treatment-resistant hypertension and chronic kidney disease: another cardiovascular-renal syndrome? Adv Chronic Kidney Dis, 21(6), 489–499. https://doi.org/10.1053/j.ackd.2014.08.006
Vemulapalli, Sreekanth, Crystal C. Tyson, and Laura P. Svetkey. “Apparent treatment-resistant hypertension and chronic kidney disease: another cardiovascular-renal syndrome?Adv Chronic Kidney Dis 21, no. 6 (November 2014): 489–99. https://doi.org/10.1053/j.ackd.2014.08.006.
Vemulapalli S, Tyson CC, Svetkey LP. Apparent treatment-resistant hypertension and chronic kidney disease: another cardiovascular-renal syndrome? Adv Chronic Kidney Dis. 2014 Nov;21(6):489–99.
Vemulapalli, Sreekanth, et al. “Apparent treatment-resistant hypertension and chronic kidney disease: another cardiovascular-renal syndrome?Adv Chronic Kidney Dis, vol. 21, no. 6, Nov. 2014, pp. 489–99. Pubmed, doi:10.1053/j.ackd.2014.08.006.
Vemulapalli S, Tyson CC, Svetkey LP. Apparent treatment-resistant hypertension and chronic kidney disease: another cardiovascular-renal syndrome? Adv Chronic Kidney Dis. 2014 Nov;21(6):489–499.
Journal cover image

Published In

Adv Chronic Kidney Dis

DOI

EISSN

1548-5609

Publication Date

November 2014

Volume

21

Issue

6

Start / End Page

489 / 499

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Sympathetic Nervous System
  • Sympathectomy
  • Renin-Angiotensin System
  • Renal Insufficiency, Chronic
  • Receptors, Mineralocorticoid
  • Pressoreceptors
  • Hypertension
  • Humans
  • Electric Stimulation Therapy