Apparent treatment-resistant hypertension and risk for stroke, coronary heart disease, and all-cause mortality
Open accessAbstract
Apparent treatment-resistant hypertension (aTRH) is defined as uncontrolled hypertension despite the use of three or more antihypertensive medication classes or controlled hypertension while treated with four or more antihypertensive medication classes. We evaluated the association of aTRH with incident stroke, coronary heart disease (CHD), and all-cause mortality. Participants from the population-based REasons for Geographic And Racial Differences in Stroke (REGARDS) Study treated for hypertension with aTRH (n = 2043) and without aTRH (n = 12,479) were included. aTRH was further categorized as controlled aTRH (≥4 medication classes and controlled hypertension) and uncontrolled aTRH (≥3 medication classes and uncontrolled hypertension). Over a median of 5.9, 4.4, and 6.0 years of follow-up, the multivariable adjusted hazard ratio for stroke, CHD, and all-cause mortality associated with aTRH versus no aTRH was 1.25 (0.94-1.65), 1.69 (1.27-2.24), and 1.29 (1.14-1.46), respectively. Compared with controlled aTRH, uncontrolled aTRH was associated with CHD (hazard ratio, 2.33; 95% confidence interval, 1.21-4.48), but not stroke or mortality. Comparing controlled aTRH with no aTRH, risk of stroke, CHD, and all-cause mortality was not elevated. aTRH was associated with an increased risk for coronary heart disease and all-cause mortality.
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Resistant hypertension is associated with an increased risk of adverse outcomes compared with non-resistant hypertension.
“The importance of RH is underscored by the associated risk of adverse outcomes compared with non-RH.”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [28]
In the REGARDS study, control status was not associated with differences in stroke or mortality.
“Control status was not associated with differences in stroke or mortality.28”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [28]
Among patients with resistant hypertension, lower blood pressure is associated with reduced risk for some cardiovascular events.
“Among patients with RH, lower BP is associated with reduced risk for some cardiovascular events.28,37”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [28]
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- Authors
- Irvin, M. R., Booth, J. N., Shimbo, D., Lackland, D. T., Oparil, S., Howard, G., Safford, M. M., Muntner, P., & Calhoun, D. A.
- Affiliations
- University of Alabama at Birmingham (US)
- Columbia University Irving Medical Center (US)
- Medical University of South Carolina (US)
- Corresponding author
- Irvin, Marguerite R.
- ORCID
- Venue
- Journal of the American Society of Hypertension
- Publisher
- Elsevier BV
- Published
- 2014-06
- Volume
- 8
- Issue
- 6
- Pages
- 405-413
- ISSN
- 1878-7436 (ISSN-L)
- 1933-1711
- PMC
- PMC4120268
- OpenAlex
- W2083024896
- Cited by
- 146
- References
- 40
- Citations by year
- 2026: 9 · 2025: 9 · 2024: 12 · 2023: 8 · 2022: 10 · 2021: 10 · 2020: 16 · 2019: 16 · 2018: 10 · 2017: 14 · 2016: 16 · 2015: 14 · 2014: 1 · 2013: 1
- FWCI
- 10.21
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Society of Hypertension (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Columbia Academic Commons (Columbia University)
- Funders
- National Institutes of Health (NS041588)
- National Heart, Lung, and Blood Institute (R01HL080477)
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK079626)
- National Institute of Neurological Disorders and Stroke (U01NS041588, NS 041588, R01NS041588)
- National Institute on Minority Health and Health Disparities (P20MD006899)
- 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 › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Keywords
- apparent treatment-resistant hypertension, uncontrolled hypertension, antihypertensive drugs, stroke, coronary artery disease, all-cause mortality, REGARDS study, cardiovascular risk
- MeSH terms
- Aged, Antihypertensive Agents, Blood Pressure, Cause of Death, Coronary Disease, Female, Follow-Up Studies, Humans, Hypertension, Male, Middle Aged, Retrospective Studies, Risk Factors, United States, Incidence, Prevalence, Survival Rate, Stroke
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