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

Abstract

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.

Clinical characteristics and outcomes of Chinese patients with coronary heart disease and resistant hypertension

“… 6 , 7 Hypertension is one of the most important risk factors for cardiovascular morbidity and mortality, especially stroke, ischemic heart disease, chronic kidney disease (CKD), congestive HF, aortic aneurysm, and peripheral arterial disease (PAD). 8 , 9 , 10 Compared with the controlled hypertension, the risk of resistant hypertension in all‐cause mortality, cardiovascular mortality, and non‐fatal stroke increased significantly. 11 , 12 …”

“…6,7 Hypertension is one of the most important risk factors for cardiovascular morbidity and mortality, especially stroke, ischemic heart disease, chronic kidney disease (CKD), congestive HF, aortic aneurysm, and peripheral arterial disease (PAD). [8][9][10] Compared with the controlled hypertension, the risk of resistant hypertension in all-cause mortality, cardiovascular mortality, and non-fatal stroke increased significantly. 11,12 The results of the REACH trial show that in patients with the entire atherosclerotic disease spectrum, whether it is currently asymptomatic, in the subclinical or has been identified in patients with single or multiple vascular disease, resistant hypertension caused varying degrees of adverse results.…”

A risk prediction nomogram for resistant hypertension in patients with obstructive sleep apnea

“…Hypertension is one of the most important risk factors for cardiovascular disease related to death, especially stroke, ischemic heart disease, congestive heart failure, aortic aneurysm and peripheral arterial disease 38 , 39 . RH patients suffer a higher risk of end-organ damage contributing to death in comparison to those with controlled blood pressure, including carotid stenosis, retinopathy, left ventricular hypertrophy and heart failure, myocardial infraction, stroke, impaired renal function 40 , 41 .…”

Hypertension Management in Patients with Chronic Kidney Disease

“…Resistant hypertension, defined as uncontrolled BP despite using three antihypertensive medications, one of which is a diuretic, is common with CKD. 53 Prior to diagnosing an individual with resistant hypertension, clinicians should confirm accurate clinic BP measurements as well as use out-of-office BP measurements to exclude pseudo-resistance. Mineralocorticoid receptor antagonists (MRA) such as spironolactone and eplerenone have been found to reduce BP in resistant hypertension.…”