TY - JOUR
T1 - Apparent Treatment-Resistant Hypertension and Cardiovascular Risk in Hemodialysis Patients
T2 - Ten-Year Outcomes of the Q-Cohort Study
AU - Tanaka, Shigeru
AU - Ninomiya, Toshiharu
AU - Hiyamuta, Hiroto
AU - Taniguchi, Masatomo
AU - Tokumoto, Masanori
AU - Masutani, Kosuke
AU - Ooboshi, Hiroaki
AU - Nakano, Toshiaki
AU - Tsuruya, Kazuhiko
AU - Kitazono, Takanari
N1 - Funding Information:
The authors would like to express their appreciation to the following investigators at the participating institutions. We thank the participants in the Q-cohort study, members of the Society for the Study of Kidney Disease, and all personnel at participating institutions involved in the study. The following personnel (institutions) participated in the study: Takashi Ando (Hakozaki Park Internal Medicine Clinic), Takashi Ariyoshi (Ariyoshi Clinic), Koichiro Goto (Goto Clinic), Fumitada Hattori (Nagao Hospital), Harumichi Higashi (St. Mary’s Hospital), Tadashi Hirano (Hakujyuji Hospital), Kei Hori (Munakata Medical Association Hospital), Takashi Inenaga (Ekisaikai Moji Hospital), Hidetoshi Kanai (Kokura Memorial Hospital), Shigemi Kiyama (Kiyama Naika), Tetsuo Komota (Komota Clinic), Hiromasa Kuma (Kuma Clinic), Toshiro Maeda (Kozenkai-Maeda Hospital), Junichi Makino (Makino Clinic), Dai Matsuo (Hirao Clinic), Chiaki Miishima (Miishima Naika Clinic), Koji Mitsuiki (Japanese Red Cross Fukuoka Hospital), Kenichi Motomura (Motomura Naika Clinic), Sadatoshi Nakamura and Hidetoshi Nakamura (Kokura Daiichi Hospital), Koichi Nakashima (Ohashi Internal Circulatory Clinic), Nobumitsu Okita (Shiroishi Kyoritsu Hospital), Shinichiro Osato (Osato Jin Clinic), Sakura Sakamoto (Fujiyamato Spa Hospital), Keiko Shigematsu (Shigematsu Clinic), Kazumasa Shimamatsu (Shimamatsu Naika Iin), Yoshito Shogakiuchi (Shin-Ai Clinic), Hiroaki Takamura (Hara Hospital), Kazuhito Takeda (Iizuka Hospital), Asuka Terai (Chidoribashi Hospital), Hideyoshi Tanaka (Mojiko-Jin Clinic), Suguru Tomooka (Hakozaki Park Internal Medicine Clinic), Jiro Toyonaga (Fukuoka Renal Clinic), Hiroshi Tsuruta (Steel Memorial Yawata Hospital), Ryutaro Yamaguchi (Shiseikai Hospital), Taihei Yanagida (Saiseikai Yahata General Hospital), Tetsuro Yanase (Yanase Internal Medicine Clinic), Tetsuhiko Yoshida (Hamanomachi Hospital), Takahiro Yoshimitsu (Gofukumachi Kidney Clinic, Harasanshin Hospital), and Koji Yoshitomi (Yoshitomi Medical Clinic). This study was supported by the Kidney Foundation (H19 JKFB 07-13, H20 JKFB 08-8, and H23 JKFB 11-11) and the Japan Dialysis Outcome Research Foundation (H19-076-02 and H20-003). We thank Jane Charbonneau, DVM, from Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.
PY - 2019/12/1
Y1 - 2019/12/1
N2 - There has been limited data discussing the relationship between apparent treatment-resistant hypertension (ATRH) and cardiovascular disease risk in patients receiving maintenance hemodialysis. We analyzed data for 2999 hypertensive patients on maintenance hemodialysis. ATRH was defined as uncontrolled blood pressure despite the use of three or more classes of antihypertensive medications, or four or more classes of antihypertensive medications regardless of blood pressure level. We examined the relationships between ATRH and cardiovascular events using a Cox proportional hazards model. The proportion of participants with ATRH was 18.0% (539/2999). During follow-up (median: 106.6 months, interquartile range: 51.3–121.8 months), 931 patients experienced cardiovascular events including coronary heart disease (n = 424), hemorrhagic stroke (n = 158), ischemic stroke (n = 344), and peripheral arterial disease (n = 242). Compared with the non-ATRH group, the ATRH group showed a significant increased risk of developing cardiovascular disease (hazard ratio [HR]: 1.27; 95% confidence interval [CI]: 1.08–1.49), coronary heart disease (HR: 1.28; 95% CI: 1.01–1.62), ischemic stroke (HR: 1.31; 95% CI: 1.01–1.69), and peripheral arterial disease (HR: 1.42; 95% CI: 1.06–1.91) even after adjusting for potential confounders. This study demonstrated that ATRH was significantly associated with increased cardiovascular risk in hemodialysis patients.
AB - There has been limited data discussing the relationship between apparent treatment-resistant hypertension (ATRH) and cardiovascular disease risk in patients receiving maintenance hemodialysis. We analyzed data for 2999 hypertensive patients on maintenance hemodialysis. ATRH was defined as uncontrolled blood pressure despite the use of three or more classes of antihypertensive medications, or four or more classes of antihypertensive medications regardless of blood pressure level. We examined the relationships between ATRH and cardiovascular events using a Cox proportional hazards model. The proportion of participants with ATRH was 18.0% (539/2999). During follow-up (median: 106.6 months, interquartile range: 51.3–121.8 months), 931 patients experienced cardiovascular events including coronary heart disease (n = 424), hemorrhagic stroke (n = 158), ischemic stroke (n = 344), and peripheral arterial disease (n = 242). Compared with the non-ATRH group, the ATRH group showed a significant increased risk of developing cardiovascular disease (hazard ratio [HR]: 1.27; 95% confidence interval [CI]: 1.08–1.49), coronary heart disease (HR: 1.28; 95% CI: 1.01–1.62), ischemic stroke (HR: 1.31; 95% CI: 1.01–1.69), and peripheral arterial disease (HR: 1.42; 95% CI: 1.06–1.91) even after adjusting for potential confounders. This study demonstrated that ATRH was significantly associated with increased cardiovascular risk in hemodialysis patients.
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U2 - 10.1038/s41598-018-37961-1
DO - 10.1038/s41598-018-37961-1
M3 - Article
C2 - 30705378
AN - SCOPUS:85060943347
VL - 9
JO - Scientific Reports
JF - Scientific Reports
SN - 2045-2322
IS - 1
M1 - 1043
ER -