Apparent treatment-resistant hypertension and risk for stroke, coronary heart disease, and all-cause mortality

• Published in: Journal of the American Society of Hypertension Vol. 8; no. 6; pp. 405 - 413
• Main Authors: Irvin, Marguerite R., PhD, Booth, John N., MSPH, Shimbo, Daichi, MD, Lackland, Daniel T., PhD, Oparil, Suzanne, MD, Howard, George, PhD, Safford, Monika M., MD, Muntner, Paul, PhD, Calhoun, David A., MD
• Format: Journal Article
• Language: English
• Published: United States 01.06.2014
• Subjects: Aged; Antihypertensive Agents - therapeutic use; Blood Pressure - drug effects; Cardiovascular; Cause of Death - trends; Coronary Disease - epidemiology; Coronary Disease - etiology; Coronary Disease - prevention & control; Female; Follow-Up Studies; Humans; Hypertension - complications; Hypertension - drug therapy; Hypertension - mortality; Incidence; Male; Middle Aged; Prevalence; Retrospective Studies; Risk Factors; Stroke - epidemiology; Stroke - etiology; Stroke - prevention & control; Survival Rate - trends; United States - epidemiology; United States; severe hypertension; antihypertensives; Resistant hypertension; outcomes
• ISSN: 1933-1711; 1878-7436; 1878-7436
• DOI: 10.1016/j.jash.2014.03.003

Abstract Apparent treatment-resistant hypertension (aTRH) is defined as uncontrolled hypertension despite the use of three or more antihypertensive medication classes or controlled hypertension while treated with four or more antihypertensive medication classes. We evaluated the association of aTRH with incident stroke, coronary heart disease (CHD), and all-cause mortality. Participants from the population-based REasons for Geographic And Racial Differences in Stroke (REGARDS) Study treated for hypertension with aTRH (n = 2043) and without aTRH (n = 12,479) were included. aTRH was further categorized as controlled aTRH (≥4 medication classes and controlled hypertension) and uncontrolled aTRH (≥3 medication classes and uncontrolled hypertension). Over a median of 5.9, 4.4, and 6.0 years of follow-up, the multivariable adjusted hazard ratio for stroke, CHD, and all-cause mortality associated with aTRH versus no aTRH was 1.25 (0.94–1.65), 1.69 (1.27–2.24), and 1.29 (1.14–1.46), respectively. Compared with controlled aTRH, uncontrolled aTRH was associated with CHD (hazard ratio, 2.33; 95% confidence interval, 1.21–4.48), but not stroke or mortality. Comparing controlled aTRH with no aTRH, risk of stroke, CHD, and all-cause mortality was not elevated. aTRH was associated with an increased risk for coronary heart disease and all-cause mortality.