Predictors and outcomes of resistant hypertension among patients with coronary artery disease and hypertension.

Abstract

OBJECTIVE:

Resistant hypertension (res-HTN) is a challenging problem, but little is known of res-HTN in patients with coronary artery disease (CAD). In this post-hoc INternational VErapamil SR-Trandolapril STudy (INVEST) analysis, we assessed prevalence, predictors, and impact on outcomes of res-HTN in CAD patients with hypertension.

METHODS:

Participants (n=17190) were divided into three groups according to achieved blood pressure (BP): controlled (BP <140/90 mmHg on three or fewer drugs); uncontrolled (BP ≥ 40/90 mmHg on two or fewer drugs); or resistant (BP ≥ 40/90 mmHg on three drugs or any patient on at least four drugs).

RESULTS:

The prevalence of res-HTN was 38%: significant predictors of res-HTN included heart failure [odds ratio (OR) 1.73], diabetes (OR 1.63), Black race (OR 1.50), and US residence (OR 1.50). Compared with controlled HTN, res-HTN had multivariate-adjusted association with higher risk of adverse outcomes {first occurrence of all-cause death, nonfatal myocardial infarction, or nonfatal stroke [hazard ratio 1.27, 95% confidence interval (CI) 1.13-1.43], and individual outcomes of all-cause death (hazard ratio 1.29, 95% CI 1.13-1.48), cardiovascular mortality (hazard ratio 1.47, 95% CI 1.21-1.78), and nonfatal stroke (hazard ratio 1.61, 95% CI 1.17-2.22), but not nonfatal myocardial infarction (hazard ratio 0.98, 95% CI 0.72-1.34)}. Adverse outcomes, except nonfatal stroke, did not differ in patients with res-HTN compared to uncontrolled HTN.

CONCLUSIONS:

Res-HTN is common in patients with CAD and hypertension, associated with poor prognosis, and linked with a number of conditions. Emphasis should be placed on recognizing those at risk for res-HTN and future studies should examine whether more aggressive treatment of res-HTN improves outcomes.

• Authors: Steven M Smith, Yan Gong, Eileen Handberg, Franz H Messerli, George L Bakris, Ali Ahmed, Anthony A Bavry, Carl J Pepine, Rhonda M Cooper-Dehoff
• Journal: Journal of hypertension (J Hypertens) Vol. 32 Issue 3 Pg. 635-43 (Mar 2014) ISSN: 1473-5598 [Electronic] England
• PMID: 24299915 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Antihypertensive Agents

Topics

• Aged
• Antihypertensive Agents (administration & dosage)
• Blood Pressure (drug effects)
• Coronary Artery Disease (complications, epidemiology, mortality)
• Drug Resistance
• Drug Therapy, Combination
• Female
• Humans
• Hypertension (complications, drug therapy, physiopathology)
• Male
• Middle Aged
• Prospective Studies
• Risk Factors
• Treatment Outcome