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Cited by 115Blood Pressure and Hypertension StudiesCardiovascular Health and Disease PreventionHormonal Regulation and Hypertension

Predictors and outcomes of resistant hypertension among patients with coronary artery disease and hypertension

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Smith, Steven M., Gong, Yan, Handberg, Eileen, Messerli, Franz H., Bakris, George L., Ahmed, Ali, Bavry, Anthony A., Pepine, Carl J. +1 more·2014·Journal of Hypertension
DOI 10.1097/hjh.0000000000000051PMC PMC4118668
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Abstract

OBJECTIVE: Resistant hypertension (res-HTN) is a challenging problem, but little is known of res-HTN in patients with coronary artery disease (CAD). In this post-hoc INternational VErapamil SR-Trandolapril STudy (INVEST) analysis, we assessed prevalence, predictors, and impact on outcomes of res-HTN in CAD patients with hypertension. METHODS: Participants (n=17190) were divided into three groups according to achieved blood pressure (BP): controlled (BP <140/90 mmHg on three or fewer drugs); uncontrolled (BP ≥ 40/90 mmHg on two or fewer drugs); or resistant (BP ≥ 40/90 mmHg on three drugs or any patient on at least four drugs). RESULTS: The prevalence of res-HTN was 38%: significant predictors of res-HTN included heart failure [odds ratio (OR) 1.73], diabetes (OR 1.63), Black race (OR 1.50), and US residence (OR 1.50). Compared with controlled HTN, res-HTN had multivariate-adjusted association with higher risk of adverse outcomes {first occurrence of all-cause death, nonfatal myocardial infarction, or nonfatal stroke [hazard ratio 1.27, 95% confidence interval (CI) 1.13-1.43], and individual outcomes of all-cause death (hazard ratio 1.29, 95% CI 1.13-1.48), cardiovascular mortality (hazard ratio 1.47, 95% CI 1.21-1.78), and nonfatal stroke (hazard ratio 1.61, 95% CI 1.17-2.22), but not nonfatal myocardial infarction (hazard ratio 0.98, 95% CI 0.72-1.34)}. Adverse outcomes, except nonfatal stroke, did not differ in patients with res-HTN compared to uncontrolled HTN. CONCLUSIONS: Res-HTN is common in patients with CAD and hypertension, associated with poor prognosis, and linked with a number of conditions. Emphasis should be placed on recognizing those at risk for res-HTN and future studies should examine whether more aggressive treatment of res-HTN improves outcomes.

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  • The higher prevalence of apparent treatment-resistant hypertension among treated hypertensive adults in clinical trials (34%-39%) is likely explained by the selection of patients with demographic and comorbidity characteristics that place them at high risk for the fatal and nonfatal cardiovascular disease outcomes of interest.

    “The higher prevalence of aTRH among treated hypertensive adults in clinical trials (34%−39%) is likely explained by the selection of patients with demographic and comorbidity characteristics that place them at high risk for the fatal and nonfatal CVD outcomes of interest.21–26”

    From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [26]

  • 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 [26]

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Authors
Smith, S. M., Gong, Y., Handberg, E., Messerli, F. H., Bakris, G. L., Ahmed, A., Bavry, A. A., Pepine, C. J., & Cooper-DeHoff, R. M.
Affiliations
  • St. Luke's-Roosevelt Hospital Center (US)
  • University of Florida (US)
  • Rush University (US)
  • University of Alabama (US)
ORCID
Venue
Journal of Hypertension
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2014-03
Volume
32
Issue
3
Pages
635-643
ISSN
0263-6352 (ISSN-L)
DOI
10.1097/hjh.0000000000000051
PMC
PMC4118668
OpenAlex
W1986336039
Cited by
115
References
31
Citations by year
2026: 4 · 2025: 4 · 2024: 10 · 2023: 13 · 2022: 7 · 2021: 9 · 2020: 6 · 2019: 7 · 2018: 9 · 2017: 10 · 2016: 13 · 2015: 13 · 2014: 10
FWCI
8.15
Type
journal article
Language
en
Open access
Locations
  • Journal of Hypertension (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Heart, Lung, and Blood Institute (K23HL086558)
  • National Institute of General Medical Sciences (U01GM074492)
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, coronary artery disease, hypertension, heart failure, diabetes mellitus, Black race, all-cause mortality, cardiovascular mortality, non-fatal stroke, nonfatal myocardial infarction, INVEST trial, verapamil, trandolapril
MeSH terms
Aged, Antihypertensive Agents, Blood Pressure, Coronary Artery Disease, Drug Resistance, Drug Therapy, Combination, Female, Humans, Hypertension, Male, Middle Aged, Prospective Studies, Risk Factors, Treatment Outcome

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