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The authors analyzed 1741 Jackson Heart Study participants without <jats:styled-content style=\"fixed-case\">aTRH<\/jats:styled-content> taking antihypertensive medication at baseline. <jats:styled-content style=\"fixed-case\">aTRH<\/jats:styled-content> was defined as uncontrolled blood pressure while taking three antihypertensive medication classes or taking four or more antihypertensive medication classes, regardless of blood pressure level. <jats:styled-content style=\"fixed-case\">CKD<\/jats:styled-content> was defined as an albumin to creatinine ratio \u226530\u00a0mg\/g or estimated glomerular filtration rate &lt;60\u00a0<jats:styled-content style=\"fixed-case\">mL<\/jats:styled-content>\/min\/1.73\u00a0m<jats:sup>2<\/jats:sup>. Over 8\u00a0years, 20.1% of participants without <jats:styled-content style=\"fixed-case\">CKD<\/jats:styled-content> and 30.5% with <jats:styled-content style=\"fixed-case\">CKD<\/jats:styled-content> developed <jats:styled-content style=\"fixed-case\">aTRH<\/jats:styled-content>. The multivariable\u2010adjusted hazard ratio for <jats:styled-content style=\"fixed-case\">aTRH<\/jats:styled-content> comparing participants with <jats:styled-content style=\"fixed-case\">CKD<\/jats:styled-content> vs those without <jats:styled-content style=\"fixed-case\">CKD<\/jats:styled-content> was 1.45 (95% <jats:styled-content style=\"fixed-case\">CI,<\/jats:styled-content> 1.12\u20131.86). Participants with <jats:styled-content style=\"fixed-case\">an albumin to creatinine ratio<\/jats:styled-content> \u226530 vs &lt;30\u00a0mg\/g (<jats:styled-content style=\"fixed-case\">hazard ratio,<\/jats:styled-content> 1.44; 95% <jats:styled-content style=\"fixed-case\">CI,<\/jats:styled-content> 1.04\u20132.00) and <jats:styled-content style=\"fixed-case\">estimated glomerular filtration rate<\/jats:styled-content> of 45 to 59\u00a0<jats:styled-content style=\"fixed-case\">mL<\/jats:styled-content>\/min\/1.73\u00a0m<jats:sup>2<\/jats:sup> and &lt;45 vs \u226560<jats:styled-content style=\"fixed-case\">mL<\/jats:styled-content>\/min\/1.73\u00a0m<jats:sup>2<\/jats:sup> (<jats:styled-content style=\"fixed-case\">hazard ratio,<\/jats:styled-content> 1.60 [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>, 1.16\u20132.20] and 2.05 [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>, 1.28\u20133.26], respectively) were more likely to develop 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