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

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...

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Published inJournal 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
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Published United States 01.06.2014
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Abstract 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.
AbstractList 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.
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.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.
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.
Author Shimbo, Daichi, MD
Oparil, Suzanne, MD
Lackland, Daniel T., PhD
Calhoun, David A., MD
Muntner, Paul, PhD
Howard, George, PhD
Booth, John N., MSPH
Safford, Monika M., MD
Irvin, Marguerite R., PhD
AuthorAffiliation Division Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
Department of Medicine, Columbia University Medical Center, Columbia University, New York, NY
Department of Neurosciences, Medical University of South Carolina, Charleston, SC
Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
AuthorAffiliation_xml – name: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
– name: Department of Neurosciences, Medical University of South Carolina, Charleston, SC
– name: Department of Medicine, Columbia University Medical Center, Columbia University, New York, NY
– name: Division Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
– name: Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
– name: Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
Author_xml – sequence: 1
  fullname: Irvin, Marguerite R., PhD
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  fullname: Booth, John N., MSPH
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  fullname: Shimbo, Daichi, MD
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  fullname: Muntner, Paul, PhD
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  fullname: Calhoun, David A., MD
BackLink https://www.ncbi.nlm.nih.gov/pubmed/24952653$$D View this record in MEDLINE/PubMed
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Copyright © 2014 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.
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Keywords severe hypertension
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Resistant hypertension
outcomes
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Snippet Abstract Apparent treatment-resistant hypertension (aTRH) is defined as uncontrolled hypertension despite the use of three or more antihypertensive medication...
Apparent treatment-resistant hypertension (aTRH) is defined as uncontrolled hypertension despite the use of three or more antihypertensive medication classes...
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StartPage 405
SubjectTerms 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
Title Apparent treatment-resistant hypertension and risk for stroke, coronary heart disease, and all-cause mortality
URI https://www.clinicalkey.es/playcontent/1-s2.0-S1933171114001004
https://www.ncbi.nlm.nih.gov/pubmed/24952653
https://www.proquest.com/docview/1539710343
https://pubmed.ncbi.nlm.nih.gov/PMC4120268
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