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.

IF 4.3 3区材料科学 Q1 ENGINEERING, ELECTRICAL & ELECTRONIC ACS Applied Electronic Materials Pub Date : 2024-05-15 DOI:10.1093/ajh/hpae020

George Bakris, Cindy Chen, Alicia K Campbell, Veronica Ashton, Lloyd Haskell, Mukul Singhal

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Abstract

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.

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血压控制对明显耐药或难以控制的高血压患者以及第 3 和第 4 期慢性肾脏病患者的实际影响。

背景：慢性肾脏病（CKD）是明显耐药高血压（aTRH）患者的常见合并症。我们评估了明显难治性高血压（aTRH）或难治性高血压和 3-4 期 CKD 患者未控制与已控制血压（BP）的临床结局、医疗资源利用事件和成本：这项回顾性队列研究使用了关联的 IQVIA Ambulatory EMR-US 和 IQVIA PharMetrics® Plus 索偿数据库。成人患者在 2015 年 1 月 1 日至 2021 年 6 月 30 日期间的 30 天内报销的抗高血压药物种类≥3 种，2 次门诊血压测量记录间隔 1-90 天，≥1 次报销的 ICD-9/10-CM 诊断代码为 CKD 3/4，且连续注册时间≥1 年。基线血压被定义为未控制（≥130/80 mmHg）或已控制（结果：在 3,966 名使用≥3 种降压药物的 3-4 期 CKD 患者中，2,479 人血压未受控制，1,487 人血压已受控制。调整基线差异后，血压未受控制的患者与血压受控的患者相比，MACE+（危险比[95% CI]：1.18 [1.03-1.36]）、ESRD（1.85 [1.44-2.39]）、住院治疗（比率比[95% CI]：1.35[1.28-1.43]）、门诊就诊率（1.12[1.11-1.12]），并产生较高的医疗和药学总费用（平均差异[95% CI]：每位患者每年 10,055 美元[6,741-13,646 美元]）：结论：与服用≥3 种降压药且血压得到控制的患者相比，患有 aTRH 和 3-4 期 CKD 且血压未得到控制的患者发生 MACE+ 和 ESRD 的风险更高，医疗资源利用率和医疗支出也更高。

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