Treatment-resistant hypertension and the incidence of cardiovascular disease and end-stage renal disease: results from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)

• Published in: Hypertension (Dallas, Tex. 1979) Vol. 64; no. 5; pp. 1012 - 1021
• Main Authors: Muntner, Paul, Davis, Barry R, Cushman, William C, Bangalore, Sripal, Calhoun, David A, Pressel, Sara L, Black, Henry R, Kostis, John B, Probstfield, Jeffrey L, Whelton, Paul K, Rahman, Mahboob
• Format: Journal Article
• Language: English
• Published: United States 01.11.2014
• Subjects: Aged; Antihypertensive Agents - pharmacology; Antihypertensive Agents - therapeutic use; Blood Pressure - drug effects; Blood Pressure - physiology; Cardiovascular Diseases - epidemiology; Drug Resistance; Female; Follow-Up Studies; Humans; Hypertension - complications; Hypertension - drug therapy; Hypertension - physiopathology; Hypolipidemic Agents - therapeutic use; Incidence; Kidney Failure, Chronic - epidemiology; Male; Middle Aged; Myocardial Infarction - prevention & control; Risk Factors; Treatment Failure; Treatment Outcome; kidney failure, chronic; cardiovascular diseases; antihypertensive; diuretics; agents
• ISSN: 0194-911X; 1524-4563
• DOI: 10.1161/HYPERTENSIONAHA.114.03850

Apparent treatment-resistant hypertension (aTRH) is defined as uncontrolled hypertension despite the use of ≥3 antihypertensive medication classes or controlled hypertension while treated with ≥4 antihypertensive medication classes. Although a high prevalence of aTRH has been reported, few data are available on its association with cardiovascular and renal outcomes. We analyzed data on 14 684 Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) participants to determine the association between aTRH (n=1870) with coronary heart disease, stroke, all-cause mortality, heart failure, peripheral artery disease, and end-stage renal disease. We defined aTRH as blood pressure not at goal (systolic/diastolic blood pressure ≥140/90 mm Hg) while taking ≥3 classes of antihypertensive medication or taking ≥4 classes of antihypertensive medication with blood pressure at goal during the year 2 ALLHAT study visit (1996-2000). Use of a diuretic was not required to meet the definition of aTRH. Follow-up occurred through 2002. The multivariable adjusted hazard ratios (95% confidence intervals) comparing participants with versus without aTRH were as follows: coronary heart disease (1.44 [1.18-1.76]), stroke (1.57 [1.18-2.08]), all-cause mortality (1.30 [1.11-1.52]), heart failure (1.88 [1.52-2.34]), peripheral artery disease (1.23 [0.85-1.79]), and end-stage renal disease (1.95 [1.11-3.41]). aTRH was also associated with the pooled outcomes of combined coronary heart disease (hazard ratio, 1.47; 95% confidence interval, 1.26-1.71) and combined cardiovascular disease (hazard ratio, 1.46; 95% confidence interval, 1.29-1.64). These results demonstrate that aTRH increases the risk for cardiovascular disease and end-stage renal disease. Studies are needed to identify approaches to prevent aTRH and reduce risk for adverse outcomes among individuals with aTRH.