Comparative risk of renal, cardiovascular, and mortality outcomes in controlled, uncontrolled resistant, and nonresistant hypertension
Open accessAbstract
We sought to compare the risk of end-stage renal disease (ESRD), ischemic heart event (IHE), congestive heart failure (CHF), cerebrovascular accident (CVA), and all-cause mortality among 470,386 individuals with resistant and nonresistant hypertension (non-RH). Resistant hypertension (60,327 individuals) was subcategorized into two groups: 23,104 patients with cRH (controlled on four or more medicines) and 37,223 patients with uRH (uncontrolled on three or more medicines) in a 5-year retrospective cohort study. Cox proportional hazard modeling was used to estimate hazard ratios adjusting for age, gender, race, body mass index, chronic kidney disease (CKD), and comorbidities. Resistant hypertension (cRH and uRH), compared with non-RH, had multivariable adjusted hazard ratios (95% confidence intervals) of 1.32 (1.27-1.37), 1.24 (1.20-1.28), 1.46 (1.40-1.52), 1.14 (1.10-1.19), and 1.06 (1.03-1.08) for ESRD, IHE, CHF, CVA, and mortality, respectively. Comparison of uRH with cRH had hazard ratios of 1.25 (1.18-1.33), 1.04 (0.99-1.10), 0.94 (0.89-1.01), 1.23 (1.14-1.31), and 1.01 (0.97-1.05) for ESRD, IHE, CHF, CVA, and mortality, respectively. Men and Hispanics had a greater risk for ESRD within all three cohorts. Individuals with resistant hypertension had a greater risk for ESRD, IHE, CHF, CVA, and mortality. The risk of ESRD and CVA were 25% and 23% greater, respectively, in uRH compared with cRH, supporting the linkage between blood pressure and both outcomes.
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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 [29]
In another study of more than 400,000 patients, compared with patients without resistant hypertension, patients with resistant hypertension had a 32% increased risk of developing end-stage renal disease.
“In another study of >400 000 patients, compared with patients without RH, patients with RH had a 32% increased risk of developing end-stage renal disease, a 24% increased risk of an ischemic heart event, a 46% increased risk of heart failure, a 14% increased risk of stroke, and a 6% increased risk of death.29”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [29]
In that study, patients with resistant hypertension had a 46% increased risk of heart failure.
“In another study of >400 000 patients, compared with patients without RH, patients with RH had a 32% increased risk of developing end-stage renal disease, a 24% increased risk of an ischemic heart event, a 46% increased risk of heart failure, a 14% increased risk of stroke, and a 6% increased risk of death.29”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [29]
In that study, patients with resistant hypertension had a 24% increased risk of an ischemic heart event.
“In another study of >400 000 patients, compared with patients without RH, patients with RH had a 32% increased risk of developing end-stage renal disease, a 24% increased risk of an ischemic heart event, a 46% increased risk of heart failure, a 14% increased risk of stroke, and a 6% increased risk of death.29”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [29]
In that study, patients with resistant hypertension had a 14% increased risk of stroke.
“In another study of >400 000 patients, compared with patients without RH, patients with RH had a 32% increased risk of developing end-stage renal disease, a 24% increased risk of an ischemic heart event, a 46% increased risk of heart failure, a 14% increased risk of stroke, and a 6% increased risk of death.29”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [29]
In that study, patients with resistant hypertension had a 6% increased risk of death.
“In another study of >400 000 patients, compared with patients without RH, patients with RH had a 32% increased risk of developing end-stage renal disease, a 24% increased risk of an ischemic heart event, a 46% increased risk of heart failure, a 14% increased risk of stroke, and a 6% increased risk of death.29”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [29]
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- Authors
- Sim, J. J., Bhandari, S. K., Shi, J., Reynolds, K., Calhoun, D. A., Kalantar-Zadeh, K., & Jacobsen, S. J.
- Affiliations
- Kaiser Permanente (US)
- University of Alabama at Birmingham (US)
- Corresponding author
- Sim, John J.
- Venue
- Kidney International
- Publisher
- Elsevier BV
- Published
- 2015-09
- Volume
- 88
- Issue
- 3
- Pages
- 622-632
- ISSN
- 0085-2538 (ISSN-L)
- PMC
- PMC4556588
- OpenAlex
- W1544563963
- Cited by
- 238
- References
- 55
- Citations by year
- 2026: 29 · 2025: 23 · 2024: 23 · 2023: 29 · 2022: 22 · 2021: 18 · 2020: 27 · 2019: 16 · 2018: 18 · 2017: 16 · 2016: 11 · 2015: 4 · 2013: 1
- FWCI
- 11.89
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Kidney International (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion, cc-by)
- Funders
- Kaiser Permanente
- National Institutes of Health
- National Institute of Diabetes and Digestive and Kidney Diseases (K24DK091419)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Keywords
- resistant hypertension, uncontrolled hypertension, controlled hypertension, end-stage renal disease, congestive heart failure, stroke, all-cause mortality, cardiovascular risk, sex differences, Hispanic origin, chronic kidney disease
- MeSH terms
- Aged, Antihypertensive Agents, Blood Pressure, Cardiovascular Diseases, Cerebrovascular Disorders, Drug Resistance, Female, Heart Failure, Humans, Hypertension, Kidney Failure, Chronic, Male, Middle Aged, Retrospective Studies, Risk Factors, Time Factors, Multivariate Analysis, Chi-Square Distribution, Proportional Hazards Models, Treatment Outcome, Myocardial Ischemia, Risk Assessment, Disease-Free Survival, Kaplan-Meier Estimate
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