The Persistent Challenge of Resistant Hypertension in CKD

Background: Many nephrology and cardiology patients suffer from both hypertension and chronic kidney disease (CKD). These patients are burdened with complicated treatment regimens that are difficult to follow, which makes it challenging to achieve target blood pressure goals. Methods: Data from 156 US physicians (76 nephrologists and 80 cardiologists) was collected via an online survey conducted in March 2024. Results: Physicians report that half (54%) of their CKD Stage 1 and 2 patients have hypertension as a comorbidity and as these patients advance in their CKD, the prevalence of hypertension increases substantially. Approximately one-third (36%) of CKD patients with hypertension are estimated to be poorly controlled on their current treatment regimen and 14% are classified as having “resistant” hypertension, which occurs when blood pressure levels remain elevated despite treatment with maximum tolerated doses of at least three antihypertensive drugs. Both nephrologists and cardiologists rank resistant hypertension as one of the most challenging cardiorenal conditions to manage and consider it to have a high unmet need for new treatment options. Physicians report that they struggle with optimizing and simplifying medication regimens that make it feasible for patients to adhere to treatment regimens. Nephrologists and cardiologists express strong interest in newly approved and pipeline agents for hypertension. They are eager to begin prescribing aprocintentan once it is available and report that more than one-quarter of their hypertensive CKD patients are candidates for treatment. Baxdrostat (an aldosterone synthase inhibitor) also garners high interest from specialists to treat uncontrolled hypertension. As new agents become available, physicians will primarily seek information related to their respective clinical trial data, degree of advancement over other available therapies, the ability to address multiple indications, and cost implications to help them determine appropriate candidates for treatment. Conclusion: New pipeline products for hypertension, especially those tested in the CKD patient population, will offer nephrologists and cardiologists alternative treatment options to more effectively address one of the most challenging conditions that they face.