Systolic Blood Pressure and Pulse Pressure Are Predictors of Future Cardiovascular Events in Patients with True Resistant Hypertension

• Published in: Diagnostics (Basel) Vol. 13; no. 10; p. 1817
• Main Authors: Mesquita Bastos, J, Ferraz, Lisa, Pereira, Flávio G, Lopes, Susana
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 22.05.2023; MDPI
• Subjects: ambulatory blood pressure; Angina pectoris; Antihypertensive drugs; Antihypertensives; Blood pressure; Body mass index; Cardiac patients; cardiovascular prognosis; cardiovascular risk; Care and treatment; Chronic kidney failure; Diuretics; Drug dosages; Heart failure; Hypertension; Kidney diseases; Measurement; Medical prognosis; Medical research; Medicine, Experimental; Obesity; Older people; Patients; pulse pressure; Regression analysis; resistant hypertension; Stroke; systolic blood pressure; pulse pressure; ambulatory blood pressure; cardiovascular prognosis; cardiovascular risk; resistant hypertension; systolic blood pressure
• ISSN: 2075-4418; 2075-4418
• DOI: 10.3390/diagnostics13101817

Given the increased risk of cardiovascular events associated with resistant hypertension, predictive cardiovascular prognosis is extremely important. Ambulatory blood pressure monitoring (ABPM) is mandatory for resistant hypertension diagnosis, but its use for prognosis is scarce. This observational longitudinal study included 258 patients (mean age of 60.4 ± 11.2 years; 61.2% male), who underwent 24 h ABPM in a hypertension unit from 1999 to 2019. The outcomes were global cardiovascular events (cerebrovascular, coronary, and other cardiovascular events). The mean follow-up period was 6.0 ± 5.0 years. Sixty-eight cardiovascular events (61 nonfatal) were recorded. Patients who experienced cardiovascular events were generally older, with higher rates of chronic kidney disease and prior cardiovascular events. The 24 h systolic blood pressure (hazard ratio 1.44; 95% CI 1.10-1.88), night systolic blood pressure (1.35; 95% CI 1.01-1.80), and 24 h pulse pressure (2.07; 95% CI 1.17-3.67) were independent predictors of global cardiovascular events. Multivariate Cox analysis revealed a higher risk of future cardiovascular events, particularly in patients with a 24 h daytime and nighttime pulse pressure > 60 mm Hg with respective hazard ratios of 1.95; 95% CI 1.01-3.45; 2.15; 95% CI 1.21-3.83 and 2.07; 95% CI 1.17-3.67. In conclusion, APBM is a fundamental tool not only for the diagnosis of resistant hypertension, but also for predicting future cardiovascular events.