Apparent treatment-resistant hypertension and risk for stroke,coronary heart disease,and all-cause mortality |
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| Affiliation: | 1. Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA;2. Department of Medicine, Columbia University Medical Center, Columbia University, New York, NY, USA;3. Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA;4. Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA;5. Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA;6. Division Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA;1. Department of Medicine, Faculty of Medicine, McGill University, Montreal, Québec, Canada;2. Department of Medicine, University of British Columbia, Center for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada;1. Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada;2. Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA;3. Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA;4. Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA;1. Division of Nephrology, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan;2. Division of Nephrology, Department of Internal Medicine, E-Da Hospital/Department of Health Management, I-Shou University, Kaohsiung, Taiwan;3. Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan;4. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan;5. Department of Public Health, National Cheng Kung University College of Medicine, Tainan, Taiwan;6. Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan;7. Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan;2. Section of Nephrology and Hypertension, First Department of Medicine, AHEPA University Hospital, Thessaloniki, Greece;1. University of Alabama at Birmingham, Birmingham, AL;2. Atlanta VA Medical Center, Atlanta, GA;3. Emory University, Atlanta, GA;4. Medical University of South Carolina, Charleston, SC |
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| 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. |
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| Keywords: | Resistant hypertension outcomes severe hypertension antihypertensives |
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