Prevalence, Predictors, and Outcomes in Treatment-resistant Hypertension in Patients with Coronary Disease

Mortality Risk Associated With Resistant Hypertension Among Women: Analysis from Three Prospective Cohorts Encompassing the Spectrum of Women's Heart Disease

“…Importantly, the median follow-up time of >14 years in this study far surpasses the vast majority of previous analyses of RH-associated outcomes, which have typically had £5 years of follow-up. [9][10][11][12][13][14][15] Finally, our findings are remarkably consistent with a recent analysis of ALLHAT data, in which RH (Vs. non-RH) was associated with a nearly 1.4-fold increased risk of all-cause mortality over *5 years among a more homogenous group of women. 9 The mechanisms underlying the association between aRH and death are not known, but it seems reasonable to presume that requiring a greater number of antihypertensive agents to achieve BP control reflects a combination of adverse underlying disease processes.…”

“…We also found that age (adjusted HR 2.00 per decade), history of smoking (adjusted HR 1.56), history of diabetes (adjusted HR 1.70), history of PVD (adjusted HR 1.11), history of stroke/TIA (adjusted HR 1.33), renal insuffiency (2.11), and presence of ischemia (adjusted HR 1.10) were independently associated with increased risk of all-cause mortality, consistent with previous studies of RH in other populations. 10,13,38 Adjusting for these risk factors did not obscure the strong relationship between aRH and mortality, suggesting that these factors do not lie in the pathway between aRH and death.…”

“…Moreover, this is one of the first studies in men or women, to our knowledge, to assess risks associated with resistant hypertension across the spectrum of underlying cardiac disease. Previous analyses have been largely limited to patients with high risk for CV events or to specific disease-based cohorts, for example, in those with underlying coronary artery disease, 12,13 subclinical or clinical atherothrombotic disease, 11 or chronic kidney disease. 10 The most important finding from this study is the very early emergence of and sustained increased risk of death associated with aRH, particularly in women with signs and symptoms of myocardial ischemia (from WISE) or CAD (from INVEST).…”

“…7,17 Multiple lines of empiric evidence suggest that women are at greater risk of developing RH than men: mean BP is demonstrably higher in postmenopausal women than agematched men 18 ; women are more likely than men to be treated with antihypertensive drugs, but less likely to achieve BP control 1,6,[19][20][21][22] ; and female sex has been repeatedly identified as an independent predictor of RH. 6,[11][12][13]23,24 Yet, most studies of RH-associated outcomes have enrolled comparatively few women, 17 consistent with CV studies in general. [25][26][27] This lack of RH outcome data in women represents a major gap in knowledge.…”

“…6 Emerging evidence suggests that RH is associated with increased risk for major adverse cardiovascular (CV) events and mortality and worse health-related quality of life, compared with nonresistant hypertension (non-RH). [9][10][11][12][13][14][15][16] Consequently, RH has been identified as a priority research area. 7,17 Multiple lines of empiric evidence suggest that women are at greater risk of developing RH than men: mean BP is demonstrably higher in postmenopausal women than agematched men 18 ; women are more likely than men to be treated with antihypertensive drugs, but less likely to achieve BP control 1,6,[19][20][21][22] ; and female sex has been repeatedly identified as an independent predictor of RH.…”