Dynamic resistant hypertension patterns as predictors of cardiovascular morbidity: a 4-year prospective study
Abstract
OBJECTIVE: Little is known regarding the clinical course and prognosis of resistant hypertension (RHT). We evaluated predictors of persistent RHT and the associated cardiovascular risk. METHODS: We studied 1911 treated hypertensive patients (aged 59±11 years, 49% men) for a mean period of 3.9 years. At baseline, clinical data were collected and patients underwent echocardiographic measurements, routine blood testing and additional workup for exclusion of secondary causes of RHT (office-based uncontrolled hypertension under at least three drugs including a diuretic or controlled hypertension under four or more drugs). Endpoint of interest was the composite of coronary artery disease and stroke. MAIN RESULTS: Four groups were identified depending on presence or absence of RHT at baseline and follow-up: 1153 patients (60%) never having RHT, 189 (10%) with resolved RHT, 204 (11%) with incident RHT and 365 (19%) with persistent RHT. Two-thirds of the patients with RHT at baseline remained resistant at the end of the study. Independent variables associated with both incident and persistent RHT were diabetes mellitus, history of cardiovascular disease, hypertension duration, SBP, left ventricular hypertrophy and glomerular filtration rate. Persistent RHT compared with never-having RHT was associated with a 2.2-fold increased risk for cardiovascular morbidity (95% CI: 1.21-4.05, P = 0.01) after adjustment for risk factors. CONCLUSION: In treated hypertensive patients, among prospective RHT dynamic patterns, persistent RHT is frequent and independently associated with adverse cardiovascular prognosis.
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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 [30]
Prospective studies using ambulatory blood pressure monitoring have suggested an almost 2-fold increased risk of cardiovascular disease events in patients with true resistant hypertension compared with those with hypertension responsive to treatment.
“Prospective studies using ABPM have suggested an almost 2-fold increased risk of CVD events in patients with true RH compared with those with hypertension responsive to treatment.30–33”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [30]
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- Authors
- Tsioufis, C., Kasiakogias, A., Kordalis, A., Dimitriadis, K., Thomopoulos, C., Tsiachris, D., Vasileiou, P., Doumas, M., Makris, T., Papademetriou, V., Kallikazaros, I., Bakris, G., & Stefanadis, C.
- Affiliations
- National and Kapodistrian University of Athens (GR)
- General-Maternity District Hospital Helena Venizelou (GR)
- University of Chicago (US)
- Corresponding author
- Tsioufis, Costas
- ORCID
- Venue
- Journal of Hypertension
- Published
- 2014-02
- Volume
- 32
- Issue
- 2
- Pages
- 415-422
- ISSN
- 0263-6352 (ISSN-L)
- OpenAlex
- W1964602819
- Cited by
- 91
- References
- 28
- Citations by year
- 2026: 7 · 2025: 1 · 2024: 8 · 2023: 10 · 2022: 4 · 2021: 6 · 2020: 12 · 2019: 10 · 2018: 9 · 2017: 5 · 2016: 6 · 2015: 6 · 2014: 7
- FWCI
- 4.30
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Hypertension (publishedVersion)
- PubMed (publishedVersion)
- 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
- resistant hypertension, cardiovascular morbidity, coronary artery disease, stroke, duration of hypertension, left ventricular hypertrophy, diabetes mellitus, glomerular filtration rate, prognosis, treated hypertensive patients
- MeSH terms
- Aged, Antihypertensive Agents, Blood Pressure, Cardiovascular Diseases, Coronary Disease, Drug Resistance, Drug Therapy, Combination, Female, Humans, Hypertension, Male, Middle Aged, Morbidity, Prospective Studies, Risk Factors, Incidence, Stroke
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