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Hypertension (HTN) is common in CKD and represents a major target for intervention to prevent progression of renal disease. Prevalence of resistant HTN is high in nephrology clinics and adequate control of blood pressure in CKD patients is crucial as they are more likely to die from CVD before reaching ESRD and lack of BP control hastens the progression of CKD to ESRD. There is thus concern about the low rate of BP control in CKD, but whether it has improved in recent times is not known in our environment. We sought to determine prevalence and pattern of resistant HTN in dialysis naïve CKD patients in Ilorin, using the newer treatment guidelines. The case files of renal patients seen in University of Ilorin Teaching Hospital ( Jan. 2001 to Dec. 2010) were retrieved from the records department. Patients that met criteria for CKD, but are yet to commence renal replacement therapy were retrospectively studied. Resistant hypertension was taken as the persistence of blood pressure above 130/80mmHg
despite regular use of maximally tolerated doses of three anti-hypertensive drugs including a diuretic for at least one month.
Total of 180 patients (121 males, 59 females) was studied. Mean age was 49.05±15.48 years, mean systolic and diastolic BP were 146.01±24.57mmHg
and 88.44±14.62mmHg respectively. Prevalence of resistant HTN was 69% while isolated diastolic and systolic HTN accounted for 9% and 4% respectively. Overall, 82% had at least one form of resistant HTN with only 18% achieving target treatment goals. Most common combination of drug classes was angiotensin receptor blockers, angiotensin-converting enzyme inhibitors, calcium channel blockers and diuretics accounting for 35%. Resistant HTN was very high among our CKD patients using the newer guidelines on Bp control. Ignorance, poverty and poor compliance to treatment were associated with resistant HTN. We advocate aggressive management including use of more than three drugs at increasing doses especially in those having a diagnosis of PKD and CGN. Health education with an emphasis on regular clinic attendance and compliance with medication in a bid to forestall ESRD epidemic should be vigorously pursued.