Prevalence, Predictors, and Outcomes in Treatment-resistant Hypertension in Patients with Coronary Disease
Open accessAbstract
Background Increasingly, apparent treatment-resistant hypertension has been recognized. However, much of the prevalence, predictors, and outcomes are largely unknown, especially in patients with coronary artery disease.Methods We evaluated 10,001 patients with coronary artery disease who were enrolled in the Treating to New Targets trial. Apparent treatment-resistant hypertension was defined as blood pressure ≥ 140 mm Hg despite 3 antihypertensive agents or <140 mm Hg with ≥ 4 antihypertensive agents. The primary outcome was major cardiovascular events (composite of fatal coronary heart disease, nonfatal myocardial infarction, resuscitated cardiac arrest, and stroke).Results Among the 10,001 patients in the trial, 1112 (11.1%) had apparent treatment-resistant hypertension. In a multivariable model adjusting for baseline differences, the treatment-resistant hypertension group had a 64% increase in primary outcome (hazard ratio [HR], 1.64; 95% confidence interval [CI], 1.39-1.94; P < .001), driven by a 69% increase in coronary heart disease death (HR, 1.69; 95% CI, 1.22, 2.34; P = .001) and 73% increase in nonfatal myocardial infarction (HR, 1.73; 95% CI, 1.39-2.16, P < .0001) when compared with the no apparent treatment-resistant hypertension group. In addition, patients with apparent treatment-resistant hypertension had a 71% increase in major coronary event (P < .0001), 45% increase in death (P = .001), 33% increase in heart failure (P = .05), 53% increase in any cardiovascular event (P < .0001), 60% increase in any coronary event (P < .0001), 68% increase in angina (P < .0001), and 51% increase in coronary revascularization (P < .0001) when compared with the no apparent treatment-resistant hypertension group. Results were largely similar whether the definition of apparent treatment-resistant hypertension was based on a blood pressure ≥ 140 mm Hg despite 3 agents or a blood pressure <140 mm Hg with ≥ 4 agents.Conclusions In patients with coronary artery disease, apparent treatment-resistant hypertension is associated with a marked increase in the risk of cardiovascular morbidity and mortality, including an increase in all-cause death.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In patients with ischemic heart disease, resistant hypertension is associated with higher rates of adverse events, including death, myocardial infarction, and stroke.
“Similarly, in patients with ischemic heart disease, RH is associated with higher rates of adverse events, including death, myocardial infarction, and stroke.26,34,35”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [35]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Effects of intensive blood-pressure control in type 2 diabetes mellitus
(2010) · New England Journal of Medicine · doi:10.1056/nejmoa1001286 · Cited by 3,598 · see citing works
Intensive Lipid Lowering with Atorvastatin in Patients with Stable Coronary Disease
LaRosa, J. C., Grundy, S. M., Waters, D. D., Shear, C., Barter, P., Fruchart, J.-C., Gotto, A. M., Greten, H., Kastelein, J. J. P., Shepherd, J., et al. (2005) · New England Journal of Medicine · doi:10.1056/nejmoa050461 · Cited by 3,489 · see citing works
Resistant Hypertension: Diagnosis, Evaluation, and Treatment
Calhoun, D. A., Jones, D. W., Textor, S. C., Goff, D. C., Murphy, T. P., Toto, R. D., White, A. J., Cushman, W. C., White, W. B., Sica, D. A., et al. (2008) · Circulation · doi:10.1161/circulationaha.108.189141 · Cited by 2,232 · see citing works
US trends in prevalence, awareness, treatment, and control of hypertension, 1988–2008
Egan, B. M. (2010) · JAMA · doi:10.1001/jama.2010.650 · Cited by 2,197 · see citing works
Anderson, J. L., Adams, C. D., Antman, E. M., Bridges, C. R., Califf, R. M., Casey, D. E., Chavey, W. E., Fesmire, F. M., Hochman, J. S., Levin, T. N., et al. (2007) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2007.02.013 · Cited by 1,498 · see citing works
Cushman, W. C., Ford, C. E., Cutler, J. A., Margolis, K. L., Davis, B. R., Grimm, R. H., Black, H. R., Hamilton, B. P., Holland, J., Nwachuku, C., et al. (2002) · The Journal of Clinical Hypertension · doi:10.1111/j.1524-6175.2002.02045.x · Cited by 979 · see citing works
Incidence and Prognosis of Resistant Hypertension in Hypertensive Patients
Daugherty, S. L., Powers, J. D., Magid, D. J., Tavel, H. M., Masoudi, F. A., Margolis, K. L., O'Connor, P. J., Selby, J. V., & Ho, P. M. (2012) · Circulation · doi:10.1161/circulationaha.111.068064 · Cited by 930 · see citing works
Prevalence of Resistant Hypertension in the United States, 2003–2008
Persell, S. D. (2011) · Hypertension · doi:10.1161/hypertensionaha.111.170308 · Cited by 761 · see citing works
Baroreflex Activation Therapy Lowers Blood Pressure in Patients With Resistant Hypertension
Bisognano, J. D., Bakris, G., Nadim, M. K., Sanchez, L., Kroon, A. A., Schafer, J., de Leeuw, P. W., & Sica, D. A. (2011) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2011.06.008 · Cited by 600 · see citing works
Uncontrolled and Apparent Treatment Resistant Hypertension in the United States, 1988 to 2008
Egan, B. M., Zhao, Y., Axon, R. N., Brzezinski, W. A., & Ferdinand, K. C. (2011) · Circulation · doi:10.1161/circulationaha.111.030189 · Cited by 599 · see citing works
Douglas, J. G. (2003) · Archives of Internal Medicine · doi:10.1001/archinte.163.5.525 · Cited by 431 · see citing works
Bangalore, S., Messerli, F. H., Wun, C. C., Zuckerman, A., DeMicco, D. A., Kostis, J. B., & LaRosa, J. C. (2010) · European Heart Journal · doi:10.1093/eurheartj/ehq328 · Cited by 366 · see citing works
Self-citationHigh prevalence of cardiac and extracardiac target organ damage in refractory hypertension
Cuspidi, C., Macca, G., Sampieri, L., Michev, I., Salerno, M., Fusi, V., Severgnini, B., Meani, S., Magrini, F., & Zanchetti, A. (2001) · Journal of Hypertension · doi:10.1097/00004872-200111000-00018 · Cited by 303 · see citing works
What Is the Optimal Blood Pressure in Patients After Acute Coronary Syndromes?
Bangalore, S., Qin, J., Sloan, S., Murphy, S. A., Cannon, C. P., & for the PROVE IT-TIMI 22 Trial Investigators (2010) · Circulation · doi:10.1161/circulationaha.109.905687 · Cited by 227 · see citing works
Self-citationWaters, D. D., Guyton, J. R., Herrington, D. M., McGowan, M. P., WENGER, N. K., & Shear, C. L. (2004) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2003.09.031 · Cited by 200 · see citing works
Kumbhani, D. J., Steg, P. G., Cannon, C. P., Eagle, K. A., Smith, S. C., Crowley, K., Goto, S., Ohman, E. M., Bakris, G. L., Perlstein, T. S., et al. (2012) · European Heart Journal · doi:10.1093/eurheartj/ehs368 · Cited by 185 · see citing works
Prevalence and Correlates of Low Medication Adherence in Apparent Treatment‐Resistant Hypertension
Irvin, M. R., Shimbo, D., Mann, D. M., Reynolds, K., Krousel-Wood, M. A., Limdi, N. A., Lackland, D. T., Calhoun, D. A., Oparil, S., & Muntner, P. (2012) · Journal of Clinical Hypertension · doi:10.1111/j.1751-7176.2012.00690.x · Cited by 80 · see citing works
Grassi, G. M., Seravalle, G., Brambilla, G., & Mancia, G. (2012) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2011.11.005 · Cited by 27 · see citing works
Kumbhani, D. J., Steg, P. G., Cannon, C. P., Eagle, K. A., Smith, S. E., Crowley, K., Goto, S., Ohman, E. M., Bakris, G., Perlstein, T. S., et al. (2012) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(12)61734-3 · Cited by 18 · see citing works
Treatment-resistant hypertension: another Cinderella story
Messerli, F. H., & Bangalore, S. (2013) · European Heart Journal · doi:10.1093/eurheartj/eht028 · Cited by 16 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., et al. (2018) · Hypertension · doi:10.1161/hyp.0000000000000065 · Cited by 7,391 · see citing works
Carey, R. M., Calhoun, D. A., Bakris, G. L., Brook, R. D., Daugherty, S. L., Dennison-Himmelfarb, C. R., Egan, B. M., Flack, J. M., Gidding, S. S., Judd, E., et al. (2018) · Hypertension · doi:10.1161/hyp.0000000000000084 · Cited by 1,153 · see citing works
Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., et al. (2018) · Circulation · doi:10.1161/cir.0000000000000596 · Cited by 1,127 · see citing works
Rabi, D. M., McBrien, K. A., Sapir-Pichhadze, R., Nakhla, M., Ahmed, S. B., Dumanski, S. M., Butalia, S., Leung, A. A., Harris, K. C., Cloutier, L., et al. (2020) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2020.02.086 · Cited by 583 · see citing works
Sim, J. J., Bhandari, S. K., Shi, J., Reynolds, K., Calhoun, D. A., Kalantar-Zadeh, K., & Jacobsen, S. J. (2015) · Kidney International · doi:10.1038/ki.2015.142 · Cited by 238 · see citing works
Muntner, P., Davis, B. R., Cushman, W. C., Bangalore, S., Calhoun, D. A., Pressel, S. L., Black, H. R., Kostis, J. B., Probstfield, J. L., Whelton, P. K., et al. (2014) · Hypertension · doi:10.1161/hypertensionaha.114.03850 · Cited by 231 · see citing works
Self-citationThomas, G., Xie, D., Chen, H.-Y., Anderson, A. H., Appel, L. J., Bodana, S., Brecklin, C. S., Drawz, P., Flack, J. M., Miller, E. R., et al. (2016) · Hypertension · doi:10.1161/hypertensionaha.115.06487 · Cited by 190 · see citing works
Diaz, K. M., Booth, J. N., Calhoun, D. A., Irvin, M. R., Howard, G., Safford, M. M., Muntner, P., & Shimbo, D. (2014) · Hypertension · doi:10.1161/hypertensionaha.114.03565 · Cited by 72 · see citing works
Egan, B. M., Kai, B., Wagner, C. S., Henderson, J. H., Chandler, A. H., & Sinopoli, A. (2016) · The Journal of Clinical Hypertension · doi:10.1111/jch.12773 · Cited by 32 · see citing works
- Authors
- Bangalore, S., Fayyad, R., Laskey, R., DeMicco, D. A., Deedwania, P., Kostis, J. B., & Messerli, F. H.
- Affiliations
- New York University (US)
- Pfizer (United States) (US)
- University of California, San Francisco (US)
- University of Medicine and Dentistry of New Jersey (US)
- Columbia University Irving Medical Center (US)
- Corresponding author
- Bangalore, Sripal
- Venue
- The American Journal of Medicine
- Publisher
- Elsevier BV
- Published
- 2014-01
- Volume
- 127
- Issue
- 1
- Pages
- 71-81.e1
- ISSN
- 0002-9343 (ISSN-L)
- OpenAlex
- W2067046716
- Cited by
- 93
- References
- 21
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 10 · 2023: 9 · 2022: 3 · 2021: 7 · 2020: 7 · 2019: 7 · 2018: 7 · 2017: 8 · 2016: 13 · 2015: 9 · 2014: 9
- FWCI
- 7.02
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The American Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Pfizer
- Novartis
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Keywords
- treatment-resistant hypertension, coronary artery disease, antihypertensive therapy, major cardiovascular events, myocardial infarction, coronary heart disease mortality, heart failure, coronary revascularization, blood pressure control, angina pectoris, stroke, cardiac arrest, secondary prevention, cardiovascular risk stratification
- MeSH terms
- Atorvastatin, Adrenergic beta-Antagonists, Adult, Aged, Angiotensin-Converting Enzyme Inhibitors, Antihypertensive Agents, Blood Pressure, Calcium Channel Blockers, Coronary Disease, Diuretics, Double-Blind Method, Drug Administration Schedule, Drug Resistance, Female, Heptanoic Acids, Humans, Hypertension, Male, Middle Aged, Predictive Value of Tests, Pyrroles, Risk Factors, Prevalence, Multivariate Analysis, Odds Ratio, Treatment Outcome, Angiotensin Receptor Antagonists
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
