Real-World Impact of Blood Pressure Control in Patients With Apparent Treatment-Resistant or Difficult-to-Control Hypertension and Stages 3 and 4 Chronic Kidney Disease.

Autor:	Bakris G; University of Chicago Medicine, Chicago, Illinois, USA., Chen C; Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA., Campbell AK; Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA., Ashton V; Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA., Haskell L; Janssen Research & Development, LLC, Raritan, New Jersey, USA., Singhal M; Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA.
Jazyk:	angličtina
Zdroj:	American journal of hypertension [Am J Hypertens] 2024 May 15; Vol. 37 (6), pp. 438-446.
DOI:	10.1093/ajh/hpae020
Abstrakt:	Background: 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. Methods: 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. Results: 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). Conclusions: 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. (© The Author(s) 2024. Published by Oxford University Press on behalf of American Journal of Hypertension, Ltd.)
Databáze:	MEDLINE
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