{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T10:02:05Z","timestamp":1792836125684,"version":"4.5.0"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>More intensive BP goals have been recommended for patients with CKD. We estimated the prevalence of apparent treatment-resistant hypertension among patients with CKD according to the 2017 American College of Cardiology\/American Heart Association (ACC\/AHA; BP goal &lt;130\/80 mm Hg) and 2021 Kidney Disease Improving Global Outcomes (KDIGO; systolic BP &lt;120 mm Hg) guidelines in two US health care systems.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, setting, participants, &amp; measurements<\/jats:title>\n                    <jats:p>\n                      We included adults with CKD (an eGFR &lt;60 ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      ) and treated hypertension from Kaiser Permanente Southern California and the Veterans Health Administration. Using electronic health records, we identified apparent treatment-resistant hypertension on the basis of (\n                      <jats:italic toggle=\"yes\">1<\/jats:italic>\n                      ) BP above the goal while prescribed three or more classes of antihypertensive medications or (\n                      <jats:italic toggle=\"yes\">2<\/jats:italic>\n                      ) prescribed four or more classes of antihypertensive medications regardless of BP. In a sensitivity analysis, we required diuretic use to be classified as apparent treatment-resistant hypertension. We estimated the prevalence of apparent treatment-resistant hypertension per clinical guideline and by CKD stage.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 44,543 Kaiser Permanente Southern California and 241,465 Veterans Health Administration patients with CKD and treated hypertension, the prevalence rates of apparent treatment-resistant hypertension were 39% (Kaiser Permanente Southern California) and 35% (Veterans Health Administration) per the 2017 ACC\/AHA guideline and 48% (Kaiser Permanente Southern California) and 55% (Veterans Health Administration) per the 2021 KDIGO guideline. By requiring a diuretic as a criterion for apparent treatment-resistant hypertension, the prevalence rates of apparent treatment-resistant hypertension were lowered to 31% (Kaiser Permanente Southern California) and 23% (Veterans Health Administration) per the 2017 ACC\/AHA guideline. The prevalence rates of apparent treatment-resistant hypertension were progressively higher at more advanced stages of CKD (34%\/33%, 42%\/36%, 52%\/41%, and 60%\/37% for Kaiser Permanente Southern California\/Veterans Health Administration eGFR 45\u201359, 30\u201344, 15\u201329, and &lt;15 ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      , respectively) per the 2017 ACC\/AHA guideline.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Depending on the CKD stage, up to a half of patients with CKD met apparent treatment-resistant hypertension criteria.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2215\/cjn.04110422","type":"journal-article","created":{"date-parts":[[2022,9,9]],"date-time":"2022-09-09T10:56:31Z","timestamp":1662720991000},"page":"1457-1466","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":27,"title":["Prevalence of Apparent Treatment-Resistant Hypertension in Chronic Kidney Disease in Two Large US Health Care Systems"],"prefix":"10.2215","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3161-5732","authenticated-orcid":false,"given":"Jaejin","family":"An","sequence":"first","affiliation":[{"name":"Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California"},{"name":"Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5227-2479","authenticated-orcid":false,"given":"Manjula","family":"Kurella Tamura","sequence":"additional","affiliation":[{"name":"Geriatric Research and Education Clinical Center, Palo Alto Veterans Affairs Health Care System, Palo Alto, California"},{"name":"Division of Nephrology, Stanford University School of Medicine, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle C.","family":"Odden","sequence":"additional","affiliation":[{"name":"Geriatric Research and Education Clinical Center, Palo Alto Veterans Affairs Health Care System, Palo Alto, California"},{"name":"Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Ni","sequence":"additional","affiliation":[{"name":"Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5686-3022","authenticated-orcid":false,"given":"I-Chun","family":"Thomas","sequence":"additional","affiliation":[{"name":"Geriatric Research and Education Clinical Center, Palo Alto Veterans Affairs Health Care System, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria E.","family":"Montez-Rath","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Stanford University School of Medicine, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9456-8243","authenticated-orcid":false,"given":"John J.","family":"Sim","sequence":"additional","affiliation":[{"name":"Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California"},{"name":"Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,10]]},"reference":[{"key":"B1-20241015","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1136\/heartjnl-2018-313599","article-title":"Global prevalence of resistant hypertension: A meta-analysis of data from 3.2 million patients","volume":"105","author":"Noubiap","year":"2019","journal-title":"Heart"},{"key":"B2-20241015","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1161\/HYPERTENSIONAHA.115.06487","article-title":"Prevalence and prognostic significance of apparent treatment resistant hypertension in chronic kidney disease: Report from the Chronic Renal Insufficiency Cohort study","volume":"67","author":"Thomas","year":"2016","journal-title":"Hypertension"},{"key":"B3-20241015","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1161\/HYPERTENSIONAHA.120.16181","article-title":"Association of apparent 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estimate glomerular filtration rate","volume":"150","author":"Levey","year":"2009","journal-title":"Ann Intern Med"},{"key":"B10-20241015","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1016\/j.cjca.2014.01.003","article-title":"Systemic implementation strategies to improve hypertension: The Kaiser Permanente Southern California experience","volume":"30","author":"Sim","year":"2014","journal-title":"Can J Cardiol"},{"key":"B12-20241015","doi-asserted-by":"crossref","first-page":"1583","DOI":"10.2215\/CJN.00550113","article-title":"Prevalence of apparent treatment-resistant hypertension among individuals with CKD","volume":"8","author":"Tanner","year":"2013","journal-title":"Clin J Am Soc Nephrol"},{"key":"B13-20241015","doi-asserted-by":"crossref","first-page":"e510","DOI":"10.1161\/CIRCULATIONAHA.108.189141","article-title":"Resistant hypertension: Diagnosis, evaluation, and treatment: A scientific statement from the American Heart Association Professional Education 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Nephrol"}],"container-title":["Clinical Journal of the American Society of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2215\/CJN.04110422","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T13:45:07Z","timestamp":1786369507000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2215\/CJN.04110422"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10]]},"references-count":15,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.2215\/cjn.04110422","relation":{},"ISSN":["1555-9041","1555-905X"],"issn-type":[{"value":"1555-9041","type":"print"},{"value":"1555-905X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10]]},"assertion":[{"value":"2022-04-06","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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