Efficacy and safety outcomes of one generic nifedipine versus ADALAT long‐acting nifedipine for hypertension management

Data regarding the long‐term outcomes of generic antihypertensive drugs are limited. This nationwide retrospective database analysis aimed to evaluate the efficacy and safety of a generic versus brand‐name nifedipine for hypertension treatment. Patients who were prescribed generic or brand‐name nifedipine between January 1, 2008, and December 31, 2013, were identified from the National Health Insurance Research Database of Taiwan. The efficacy outcomes included all‐cause mortality and the composite cardiovascular (CV) outcome, including CV death, non‐fatal myocardial infarction, non‐fatal stroke, coronary revascularization, and hospitalization for heart failure. Safety outcomes included headache, peripheral edema, constipation, acute kidney injury, hypotension, syncope, new diagnosis of cancer, and cancer death. Among the 98 335 patients who were eligible for analysis, 21 087 (21.4%) were prescribed generic nifedipine. Both the generic and the brand‐name groups included 21 087 patients after propensity score matching. At a mean follow‐up of 4.1 years, the generic nifedipine was comparable to the brand‐name drug with regard to all‐cause mortality (7.2% vs. 7.1%; hazard ratio [HR] 1.02, 95% confidence interval [CI] 0.95–1.09) and the composite CV outcomes (11.6% vs. 11.9%; HR 0.97; 95% CI 0.92–1.03). The generic nifedipine was associated with higher rates of headache, peripheral edema, and constipation but a modest reduction in the risk of newly diagnosed cancer (7.1% vs. 7.8%; subdistribution HR 0.90, 95% CI 0.84–0.97). The risks of acute kidney injury, hypotension, syncope, and cancer death were not significantly different between the two groups. In conclusion, the generic nifedipine was comparable to the brand‐name drug with regard to the risks of all‐cause mortality and the composite CV outcome. The finding of cancer risk could be chance and should be interpreted with caution.     

左旋氨氯地平和氨氯地平治疗轻中度高血压的临床观察

目的评价左旋氨氯地平和氨氯地平治疗轻中度高血压的疗效与不良反应。方法选择门诊轻中度高血压患者108例,随机分为3组,每组36例,接受氨氯地平5 mg/d(A组)、左旋氨氯地平2.5 mg/d(B组)、左旋氨氯地平5 mg/d(C组),共治疗8周,观察降压效果和不良反应。结果 3组治疗后收缩压和舒张压较治疗前明显下降(P<0.05)。与A、B组比较,C组血压变化值更高(P<0.01),血压达标率高(P<0.05)。3组治疗后红细胞计数、血红蛋白较治疗前明显增高(P<0.05);B组血K~+明显降低(P<0.05)。结论左旋氨氯地平能有效降低轻中度高血压患者的血压,不良反应低于氨氨地平,左旋氨氯地平2.5 mg治疗后血K+下降。     

A randomized controlled trial on the blood pressure–lowering effect of amlodipine and nifedipine‐GITS in sustained hypertension

In a multicenter, randomized trial, we investigated whether the long half‐time dihydropyridine calcium channel blocker amlodipine was more efficacious than the gastrointestinal therapeutic system (GITS) formulation of nifedipine in lowering ambulatory blood pressure (BP) in sustained hypertension (clinic systolic/diastolic BP 140‐179/90‐109 mm Hg and 24‐hour systolic/diastolic BP ≥ 130/80 mm Hg). Eligible patients were randomly assigned to amlodipine 5‐10 mg/day or nifedipine‐GITS 30‐60 mg/day. Ambulatory BP monitoring was performed for 24 hours at baseline and 4‐week treatment and for 48 hours at 8‐week treatment with a dose of medication missed on the second day. After 8‐week treatment, BP was similarly reduced in the amlodipine (n = 257) and nifedipine‐GITS groups (n = 248) for both clinic and ambulatory (24‐hour systolic/diastolic BP 10.3/6.5 vs 10.9/6.3 mm Hg, P ≥ 0.24) measurements. However, after missing a dose of medication, ambulatory BP reductions were greater in the amlodipine than nifedipine‐GITS group, with a significant (P ≤ 0.04) between‐group difference in 24‐hour (–1.2 mm Hg) and daytime diastolic BP (–1.5 mm Hg). In conclusion, amlodipine and nifedipine‐GITS were efficacious in reducing 24‐hour BP. When a dose of medication was missed, amlodipine became more efficacious than nifedipine‐GITS.     

Randomized,multicenter, parallel,open, phase 4 study to compare the efficacy and safety of rosuvastatin/amlodipine polypill versus atorvastatin/amlodipine polypill in hypertension patient with dyslipidemia

The authors performed this study to investigate the efficacy and safety of a rosuvastatin (RSV)/amlodipine (AML) polypill compared with those of atorvastatin (ATV)/AML polypill. We included 259 patients from 21 institutions in Korea. Patients were randomly assigned to 1 of 3 treatment groups: RSV 10 mg/AML 5 mg, RSV 20 mg/AML 5 mg, or ATV 20 mg /AML 5 mg. The primary endpoint was the efficacy of the RSV 10.20 mg/AML 5 mg via percentage changes in LDL-C after 8 weeks of treatment, compared with the ATV 20 mg /AML 5 mg. There was a significant difference in the mean percentage change of LDL-C at 8 weeks between the RSV 10 mg/AML 5 mg and the ATV 20 mg/AML 5 mg (full analysis set [FAS]: −7.08%, 95% CI: −11.79 to −2.38, p = .0034, per-protocol analysis set [PPS]: −6.97%, 95% CI: −11.76 to −2.19, p = .0046). Also, there was a significant difference in the mean percentage change of LDL-C at 8 weeks between the RSV 20 mg/AML 5 mg and the ATV 20 mg/AML 5 mg (FAS: −10.13%, 95% CI: −15.41 to −4.84, p = .0002, PPS: −10.96%, 95% CI: −15.98 to −5.93, p < .0001). There was no significant difference in the adverse events rates between RSV 10 mg/AML 5 mg, RSV 20 mg/AML 5 mg, and ATV 20 mg/AML 5 mg. In conclusion, while maintaining safety, RSV 10 mg/AML 5 mg and the RSV 20 mg/AML 5 mg more effectively reduced LDL-C compared with the ATV 20 mg /AML 5 mg (Clinical trial: NCT03951207).     

A dose-response study of amlodipine in mild to moderate hypertension

The antihypertensive efficacy and suitability for once daily dosing of amlodipine, a new calcium antagonist, was studied in a series of 205 patients with mild to moderate hypertension. The study was conducted double-blind in 13 centres. The starting doses of amlodipine were 1.25, 2.5 and 5 mg, respectively, which were doubled after 4 weeks if normotension or a preset target blood pressure was not reached. Target blood pressure was reached in 25% of patients with placebo, 41% with 2.5 mg of amlodipine, 56% with 5 mg of amlodipine and 73% with 10 mg of amlodipine once daily. The drug was well tolerated at all dose levels and no changes occurred in heart rate, body weight or electrocardiogram during treatment. Amlodipine is a useful new calcium antagonist for the treatment of hypertension producing smooth, dose-dependent blood pressure reductions with convenient once daily dosing.     

Nisoldipine: a replacement therapy for nifedipine in the treatment of severe hypertension

The use of nisoldipine (10-20 mg b.i.d.) was evaluated as a replacement therapy for long-acting nifedipine (40-120 mg/day) in 21 patients with severe hypertension, who were resistant to or intolerant of nifedipine. Except for one patient with specific contraindications, all participants received an individually determined constant dose of beta blocker throughout the 8-month study. Results indicated a significant decrease in blood pressure after four weeks of treatment with nisoldipine (173 +/- 5/98 +/- 4 to 156 +/- 3/91 +/- 2 mmHg, p less than 0.05) without an associated change in pulse rate in 19 patients; only 5 of the 21 patients showed no further benefit from nisoldipine. No significant biochemical changes were noted in any of the patients during the study. In three patients, leg edema that had developed as a consequence of previous nifedipine therapy resolved completely following nisoldipine administration. Two patients withdrew from the study before term because of headaches and palpitations. An additional two patients suffered headaches, but tolerated the drug and continued the study. One patient suffered from polyuria. Nisoldipine appears to be an effective substitute treatment for nifedipine in severely hypertensive patients sensitive or resistant to nifedipine.     

Regression of left ventricular hypertrophy with long-term treatment of nifedipine in systemic hypertension

We investigated the regression of left ventricular (LV) hypertrophy with long-term treatment of nifedipine in patients with systemic hypertension. Echocardiograms of the LV were obtained in nine patients before and at a mean of 50 months (13-105 months) after nifedipine monotherapy (30-60 mg/day). Nifedipine significantly reduced both systolic and diastolic blood pressures (BP) by a mean of -46 mmHg and -21 mmHg, respectively. With systemic BP reduction, LV mass was significantly reduced by a mean of - 15%, associated with a decrease in LV posterior wall thickness and end-diastolic dimension. There was no significant change in LV fractional shortening. We conclude that nifedipine may cause regression of LV hypertrophy in systemic hypertension, and that reversal of the increase in LV mass could be maintained during long-term nifedipine treatment.     

硝苯地平控释片与5-单硝异山梨醇酯对稳定性心绞痛疗效的比较

目的　比较硝苯地平控释片与 5 单硝异山梨醇酯对稳定性心绞痛的疗效。方法　 5 3例稳定性心绞痛患者停用抗心绞痛药物 1周 ,然后经 2～ 3周的单盲安慰剂治疗后 ,进入为期 6周的单盲随机对照试验 ,以平板运动负荷心电图为考察指标。结果　经过 6周的治疗后 ,硝苯地平控释片( 3 0mg ,每日 1次 )与 5 单硝异山梨醇酯 ( 2 0mg ,每日 2次 )均能显著减少心绞痛发作次数 (分别下降87%和 5 1% ,P <0 0 5 )及硝酸甘油消耗量 (分别下降 91%和 5 4 % ,P <0 0 5 ) ;提高运动能力 ,延长运动时间 (分别延长 114秒和 2 5秒 ,P <0 0 1) ,且对运动能力的改善作用分别在末次服药 (疗程结束 )后 2 4小时和 12小时仍然存在。结论　硝苯地平控释片和 5 单硝异山梨醇酯均能有效改善稳定性心绞痛患者的临床症状 ,心电图及运动能力 ,其有效作用分别持续 2 4和 12小时。     

Addition of chlorthalidone to slow-release nifedipine in the treatment of arterial hypertension: A controlled study versus placebo

Summary The use of calcium antagonists and diuretics in combination for treatment of hypertension is controversial.In a single-blind study 16 patients (8 men, 8 women, age range 39 to 62 years) with primary hypertension of mild to moderate degree were given slow-release nifedipine 20 mg twice daily for 6 weeks, thereafter either chlorthalidone 25 mg (Group A) or placebo (group B) daily was randomly added for a further 6-week period.Blood pressure (BP), heart rate, plasma renin activity (PRA), aldosterone, and 24 hour urinary electrolytes were evaluated.Nifedipine decreased supine BP from 159/92±16/8 to 151/89±10/6 mmHg in group A and from 162/94±20/12 to 145/85±14/6 mmHg in group B. A further fall to 139/84±7/6 mmHg (p<.05) was observed after addition of chlorthalidone.PRA significantly increased with combined treatment compared to baseline (3.3±0.8 to 9.9±3.3 ng/ml/hr;p<0.05). A slight reduction of 24-hour urinary calcium was observed after the addition of chlorthalidone.These data indicate that the combination of nifedipine and chlorthalidone might be beneficial in the treatment of arterial hypertension.     

氨氯地平和培哚普利联合治疗对高血压病患者肾功能的影响

探讨氨氯地平，培哚普利单独治疗和联合治疗对高血压病患者肾功能的影响。方法 ６６例高血压病患者随机分为三组：氨氯地平组；培哚普利组；氨氯地平和培哚普利联合治疗组。疗程２４周，治疗前后观察肾功能指标变化。结果 １．氨氯地平，培哚普利及联合治疗组高血压病患者治疗后均能显著降低血压及尿蛋白排泄量「２４小时尿白蛋白：１０２±３６．４．１０４．７±４２．７和１０１．４±０．０６５，０．２４±０．６２及０．２３     

固定复方氨氯地平阿托伐他汀钙治疗高血压合并高脂血症患者的临床疗效及安全性

目的研究固定复方氨氯地平阿托伐他汀钙治疗高血压合并高脂血症的临床疗效及安全性。方法选择轻、中度原发性高血压合并高脂血症患者217例,随机分为试验组108例,初始剂型口服复方氨氯地平阿托伐他汀钙,1次/d;对照组109例,口服氨氯地平5 mg+阿托伐他汀钙10 mg,1次/d。4周后根据舒张压情况调整药物剂量,治疗时间为8周,观察疗效和不良事件。结果试验组和对照组治疗后收缩压、舒张压、LDL-C、TC、TG较治疗前明显降低,差异有统计学意义(P<0.01)。治疗期间2组不良事件发生率比较差异无统计学意义(P>0.05),且无严重不良事件发生。结论氨氯地平阿托伐他汀钙治疗轻、中度原发性高血压合并高脂血症患者,降压、调脂疗效确切,安全耐受性良好。固定复方片剂可为患者提供治疗上的便利。     

Double-blind comparison of amlodipine and hydrochlorothiazide in patients with mild to moderate hypertension

In the final analysis of this study at Week 26,26% of the patients randomized to receive amlodipine attained blood pressure control with amlodipine alone compared with 33% of the patients allocated to hydrochlorothiazide (HCTZ). Neither amlodipine nor HCTZ produced clinically significant changes in pulse rate or in the electrocardiogram. Amlodipine treatment did not appear to produce clinically significant changes in blood lipids; HCTZ, however, produced an increase in total plasma cholesterol (Δ22.9 ± 8.6 mg/dl). The incidence of side effects and the rate of patient withdrawal in the amlodipine and HCTZ groups were comparable. As expected, HCTZ therapy caused well-recognized biochemical alterations in cholesterol and potassium levels, whereas amlodipine was metabolically neutral.     

Ambulatory blood pressure response to S‐amlodipine in Korean adult patients with uncontrolled essential hypertension: A prospective,observational study

Although amlodipine is recommended as the first‐line therapy for the treatment of hypertension, its use is limited by its potential side effects. S‐amlodipine is expected to be able to minimize side effects of amlodipine with a similar antihypertensive effect by removing the malicious R‐chiral form. However, sustainable blood pressure control with S‐amlodipine has not been well established yet. The purpose of the current study was to evaluate ambulatory blood pressure (ABP) profiles before and after a 12‐week treatment of S‐amlodipine. Patients received once‐daily S‐amlodipine 2.5 or 5 mg. ABP during 24 hr and office blood pressure were measured at baseline and after the 12‐week treatment. Primary endpoints were changes of systolic and diastolic 24 hr ABP. After 12‐week S‐amlodipine treatment, mean systolic ABP (‐15.1 ± 16.2 mmHg, p < .001) and diastolic ABP (‐8.9 ± 9.8 mmHg, p < .001) were decreased significantly. Both daytime and night‐time mean systolic BP and diastolic BP were also significantly decreased after the 12‐week treatment. Global trough‐to‐peak ratio and smoothness index after 12‐week S‐amlodipine treatment were .75 and .79 for SBP and .65 and .61 for DBP, respectively. Age ≥65 years (hazard ratio [HR]: 3.13; 95% confidence interval [CI]: 1.67–14.3) and nonalcohol drinking (HR: 3.09; 95% CI: 1.34–7.17) were independent clinical factors for target ABP achievement. Adverse drug reactions (ADR) were developed in 16 (6.4%) patients, including two (.8%) cases of peripheral edema. In conclusion, this study demonstrated the efficacy and safety of S‐amlodipine in patients with uncontrolled essential hypertension.     

Hemodynamic effects of nifedipine and oxygen in children with pulmonary hypertension

Summary Fourteen patients, 2 to 20 years old were investigated. Two had primary pulmonary hypertension, 11 had congenital heart disease and post-tricuspid shunts, and 1, a 20-year-old patient, was investigated after he had undergone surgical correction of truncus arteriosus I. Pulmonary arterial pressure, pulmonary flow index, peripheral systolic blood pressure and heart rate were measured before, and several times after intrapulmonary injection into the pulmonary artery of 0.5 g nifedipine/kg. Six patients were given an additional dose of 1 g nifedipine per kilogram into the pulmonary artery and hemodynamic measurements were repeated. In eight children, receiving 100% oxygen via a breathing mask, nifedipine effects were compared with oxygen effects. After 10 minutes under oxygen, the same hemodynamics were determined as after nifedipine. In addition, in four of these children aortic pressure and arterial oxygen saturation were also measured. Maximal effects occurred within 4 minutes. 0.5 g nifedipine per kilogram caused a slight reduction in mean pulmonary arterial pressure (p<0.05), as well as increase in pulmonary flow index (p<0.005). However, no significant change in heart rate or in systolic blood pressure was observed. 1 g nifedipine per kilogram IP had almost the same effects. No adverse side effects occurred, besides mild headaches in one child. A comparison of nifedipine injected into the pulmonary artery with oxygen breathing in congenital heart disease combined with pulmonary hypertension, is reported for the first time. Nifedipine had a more pronounced and beneficial effect with a selective action on the pulmonary vascular bed.     

A randomized,double‐blind clinical trial to evaluate the efficacy and safety of a fixed‐dose combination of amlodipine/rosuvastatin in patients with dyslipidemia and hypertension

This multicenter, randomized, double‐blind, parallel‐group phase III clinical trial aimed to investigate the efficacy and safety of a rosuvastatin + amlodipine combination compared with that of rosuvastatin or amlodipine monotherapy in hypertensive patients with dyslipidemia. A total of 106 patients of 15 institutions in Korea were randomly assigned to 1 of 3 treatment groups: rosuvastatin 20 mg + amlodipine 10 mg, amlodipine 10 mg, or rosuvastatin 20 mg. After 8 weeks of treatment, the mean ± SD of change in mean sitting systolic blood pressure (msSBP) was −22.82 ± 12.99 mm Hg in the rosuvastatin + amlodipine group, the most decreased among the treatment groups. The percentage of patients whose msSBP decreased ≥20 mm Hg or msDBP decreased ≥10 mm Hg was also highest in this group (74.29%). The mean ± SD percentage change in low‐density lipoprotein cholesterol (LDL‐C) level from baseline after 8 weeks was −52.53% ± 11.21% in the rosuvastatin + amlodipine group, the most decreased among the treatment groups. More patients in the rosuvastatin + amlodipine group achieved their target LDL‐C goal at 8 weeks, compared with the other treatment groups (97.14%). No serious adverse events or adverse drug reactions were observed in all groups. In hypertensive patients with dyslipidemia, combination treatment with rosuvastatin 20 mg + amlodipine 10 mg effectively reduced blood pressure and LDL‐C levels while maintaining safety.     

Clinical effectiveness and safety of amlodipine/losartan‐based single‐pill combination therapy in patients with hypertension: Findings from real‐world,multicenter observational databases

Various single‐pill combinations (SPCs) have been introduced to improve drug compliance and clinical efficacy. However, there is a lack of real‐world evidence regarding the effectiveness of these SPCs for hypertension. This study evaluated the real‐world clinical efficacy and safety of amlodipine/losartan‐based SPC therapies in patients with hypertension in a real‐world setting. A total of 15 538 patients treated with amlodipine/losartan‐based SPCs [amlodipine + losartan (AL), amlodipine + losartan + rosuvastatin (ALR), and amlodipine + losartan + chlorthalidone (ALC)] were selected from the database of three tertiary hospitals in Korea. The efficacy endpoints were target blood pressure (BP) and low‐density lipoprotein cholesterol (LDL‐C) achievement rates. Safety was evaluated based on laboratory parameters. Drug adherence was defined as the proportion of medication days covered (PDC). The target BP attainment rate was above 90% and was similar among the three groups. Although many patients in the AL and ALC groups took statins, the target LDL‐C attainment rate was significantly higher in the ALR group than in the AL and ALC groups. Safety endpoints were not significantly different among the groups, except serum uric acid level and incidence rate of new‐onset hyperuricemia, which were significantly lower in the AL and ALR groups than in the ALC group. The PDC was > 90% in all groups. In the real‐world hypertensive patients, amlodipine/losartan‐based SPC therapy demonstrated good target BP achievement rates. Especially, rosuvastatin‐combination SPC showed better target LDL‐C goal achievement rate compared to the other SPCs. All three amlodipine/losartan‐based SPC had excellent drug adherence.     

Fixed‐dose combination of amlodipine and atorvastatin improves clinical outcomes in patients with concomitant hypertension and dyslipidemia

Hypertension and dyslipidemia are important risk factors for cardiovascular disease. However, the clinical outcomes of fixed‐dose combination (FDC) versus free‐equivalent combination (FEC) of amlodipine and atorvastatin in the treatment of concurrent hypertension and dyslipidemia remain unknown. In this study, we included patients with newly diagnosed hypertension and dyslipidemia, without previously established cardiovascular disease, and treated with either FDC or FEC of amlodipine and atorvastatin were identified from the National Health Insurance Research Database of Taiwan and follow‐up for 5 years. By using 1:1 propensity score matching, a total of 1756 patients were enrolled in this study. The composite of major adverse cardiovascular events, including all‐cause mortality, myocardial infarction (MI), stroke, and coronary revascularization, occurred more frequently in the FEC group than in the FDC group (hazard ratio, 1.88; 95% confidence interval [CI], 1.42 to 2.5). Although the all‐cause mortality did not differ (hazard ratio, 0.46; 95% CI, 0.36 to 1.59), the FEC group developed increased MI, stroke, and coronary revascularization (hazard ratio, 2.87; 95% CI, 1.07 to 7.68; hazard ratio, 1.97; 95% CI, 1.41 to 2.74; and hazard ratio, 2.44; 95% CI, 1.26 to 4.69, respectively). Furthermore, as an unexpected result, a higher risk to develop new‐onset diabetes mellitus was observed with FEC regimens (hazard ratio, 2.19; 95% CI, 1.6 to 3.0). In conclusion, although the all‐cause mortality did not differ between the two groups, the FDC regimen of amlodipine and atorvastatin improved clinical outcomes when compared to FEC in patients with newly diagnosed hypertension and dyslipidemia.     

硝苯啶对原发性高血压病人Macruz指数与左室舒张功能的影响

５２例原发性高血压Ⅰ－Ⅱ期病人治疗前常规心电图Ⅱ导联上Ｍａｃｒｕｚ指数阳性３６例，占７０％，正常对照组６３例，Ｍａｃｒｕｚ指数阳性３例，占５％，两组差异非常显著。高血压组用硝苯啶治疗一月后Ｍａｃｒｕｚ指数仍阳性者９例，占１７％。较治疗前有显著性差异，高血压组同时伴有左舒张功能改善。     

Non‐pharmacological management of hypertension

Hypertension is an insidious disease which predisposes to cardiovascular complications and if not treated properly can lead to various serious complications. Economic limitations, having additional benefits with few or almost no side effects have made non‐pharmacological management of hypertension an attractive approach for dealing with hypertension, in developed and developing countries alike. A MEDLINE search was done for relevant references with emphasis on original studies, randomized controlled trials, and meta‐analyses for this review paper. Lifestyle modifications including changes in the dietary pattern, adopting special diets with low sodium, saturated fat and high calcium, magnesium and potassium and trying the new methods like time restricted meal intake which work in tandem with the circadian rhythm are opening new vistas in the field of non‐pharmacological management of hypertension. Lifestyle modifications that effectively lower blood pressure are increased physical activity, weight loss, limited alcohol consumption, relaxation techniques of Yoga, Acupuncture, Tai chi, mindfulness‐based stress‐reduction program, and Transcendental Meditation. Air pollution of the surrounding air is linked with poor health outcomes and is a major contributor to the global burden of disease. Fine particulate matter <2.5 μm in diameter (PM2.5) is strongly associated with cardiovascular morbidity and mortality. Short‐term PM exposure (hours to weeks) increases the likelihood of adverse cardiovascular events including myocardial infarction, stroke, and heart failure, and longer‐term exposure multiplies that risk. Non‐pharmacological methods should be initiated early phase of disease and should be continued with medication.     

Prevalence and prognosis of the 2018 vs 2008 AHA definitions of apparent treatment‐resistant hypertension in high‐risk hypertension patients

Resistant hypertension was defined according to the 2008 scientific statement as office blood pressure ≥ 140/90 mm Hg and the 2018 scientific statement as office blood pressure ≥ 130/80 mm Hg. We investigated the prognostic significance of lowered blood pressure threshold for defining resistant hypertension in the 2018 American Heart Association scientific statement compared with that in the 2008 scientific statement. The participants of this prospective cohort were enrolled from December 2013 to November 2018. Major adverse cardiovascular events (MACEs) were defined as a composite of cardiovascular death, non‐fatal myocardial infarction, non‐fatal stroke, and heart failure hospitalization. Renal event was defined as a ≥ 50% decline in estimated glomerular filtration rate or progression to end‐stage renal disease. A total of 206 patients among 2018 (10.2%) were diagnosed with resistant hypertension by the previous definition (≥140/90 mm Hg), and 276 patients among 2011 (13.7%) were diagnosed with resistant hypertension by the updated definition (≥130/80 mm Hg). During a median follow‐up of 4.5 years, 33 MACEs (3.7 per 1000 patient‐years) and 164 renal events (19.9 per 1000 patient‐years) occurred in the study population. Treatment‐resistant hypertension groups had a higher incidence rate of MACEs and renal events than the control groups. In multivariate Cox proportional hazards regression analysis, resistant hypertension by both definitions was significantly associated with increased risk of MACE and renal event. Both the previous and updated definitions of resistant hypertension were significant predictors of MACEs and renal events. This finding supports the adoption of the updated criteria for resistant hypertension in clinical practice.