Cardiovascular and mortality risk of apparent resistant hypertension in women with suspected myocardial ischemia: a report from the NHLBI-sponsored WISE Study.

Abstract

BACKGROUND:

Women are more likely than men to develop resistant hypertension, which is associated with excess risk of major adverse outcomes; however, the impact of resistant hypertension in women with ischemia has not been explicitly studied. In this Women's Ischemia Syndrome Evaluation (WISE) analysis, we assessed long-term adverse outcomes associated with apparent treatment-resistant hypertension (aTRH) among women with suspected myocardial ischemia referred for coronary angiography.

METHODS AND RESULTS:

Women (n=927) were grouped according to baseline blood pressure (BP): normotensive (no hypertension history, BP <140/90 mm Hg, no antihypertensive drugs); controlled (BP <140/90 mm Hg and a hypertension diagnosis or on 1 to 3 drugs); uncontrolled (BP ≥140/90 mm Hg on ≤2 drugs); or aTRH (BP ≥140/90 mm Hg on 3 drugs or anyone on ≥4 drugs). Adverse outcomes (first occurrence of death [any cause], nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure or angina) were collected over 10 years of follow-up. Apparent treatment-resistant hypertension prevalence was 10.4% among those with hypertension. Women with aTRH had a greater incidence of adverse outcomes, compared with normotensive women (adjusted hazard ratio [HR], 3.25; 95% confidence interval [CI], 1.94 to 5.43), and women with controlled (HR, 1.77; 95% CI, 1.26 to 2.49) and uncontrolled (HR, 1.62; 95% CI, 1.15 to 2.27) hypertension; outcome differences were evident early in follow-up. Risk of all-cause death was greater in the aTRH group, compared to the normotensive women and women with controlled and uncontrolled hypertension.

CONCLUSIONS:

In this cohort of women with evidence of ischemia, aTRH was associated with a profoundly increased long-term risk of major adverse events, including death, that emerged early during follow-up.

• Authors: Steven M Smith, Tianyao Huo, B Delia Johnson, Vera Bittner, Sheryl F Kelsey, Diane Vido Thompson, C Noel Bairey Merz, Carl J Pepine, Rhonda M Cooper-Dehoff
• Journal: Journal of the American Heart Association (J Am Heart Assoc) Vol. 3 Issue 1 Pg. e000660 (Feb 28 2014) ISSN: 2047-9980 [Electronic] England
• PMID: 24584740 (Publication Type: Journal Article, Multicenter Study, Observational Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Antihypertensive Agents

Topics

• Adult
• Aged
• Angina Pectoris (epidemiology)
• Antihypertensive Agents (therapeutic use)
• Blood Pressure (drug effects)
• Coronary Angiography
• Drug Resistance
• Drug Therapy, Combination
• Female
• Heart Failure (epidemiology)
• Hospitalization
• Humans
• Hypertension (diagnosis, drug therapy, epidemiology, mortality)
• Kaplan-Meier Estimate
• Middle Aged
• Myocardial Infarction (epidemiology)
• Myocardial Ischemia (diagnosis, epidemiology, mortality)
• National Heart, Lung, and Blood Institute (U.S.)
• Prognosis
• Proportional Hazards Models
• Risk Factors
• Sex Factors
• Stroke (epidemiology)
• Time Factors
• United States (epidemiology)