Baseline predictors of resistant hypertension in the Anglo-Scandinavian Cardiac Outcome Trial (ASCOT): a risk score to identify those at high-risk

Gupta, Ajay K.; Nasothimiou, Efthimia G.; Chang, Choon L.; Sever, Peter S.; Dahlöf, Bjorn; Poulter, Neil R.

doi:10.1097/hjh.0b013e32834a8a42

Cited by 165Blood Pressure and Hypertension StudiesCardiovascular Health and Disease PreventionHormonal Regulation and Hypertension

Baseline predictors of resistant hypertension in the Anglo-Scandinavian Cardiac Outcome Trial (ASCOT): a risk score to identify those at high-risk

Gupta, Ajay K., Nasothimiou, Efthimia G., Chang, Choon L., Sever, Peter S., Dahlöf, Bjorn, Poulter, Neil R.·2011·Journal of Hypertension

DOI 10.1097/hjh.0b013e32834a8a42

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Abstract

BACKGROUND: Resistant hypertension is a well recognized clinical entity, which has been inadequately researched to date. METHODS: A multivariable Cox model was developed to identify baseline predictors of developing resistant hypertension among 3666 previously untreated Anglo-Scandinavian Cardiac Outcome Trial (ASCOT) patients and construct a risk score to identify those at high risk. Secondary analyses included evaluations among all 19 257 randomized patients. RESULTS: One-third (1258) of previously untreated, and one-half (9333) of all randomized patients (incidence rates 75.2 and 129.7 per 1000 person-years, respectively) developed resistant hypertension during a median follow-up of 5.3 and 4.8 years, respectively. Increasing strata of baseline SBP (151-160, 161-170, 171-180, and >180 mmHg) were associated with increased risk of developing resistant hypertension [hazard ratio 1.24 (95% confidence interval, CI 0.81-1.88), 1.50 (1.03-2.20), 2.15 (1.47-3.16), and 4.43 (3.04-6.45), respectively]. Diabetes, left ventricular hypertrophy, male sex, and raised BMI, fasting glucose, and alcohol intake were other significant determinants of resistant hypertension. Randomization to amlodipine ± perindopril vs. atenolol ± thiazide [0.57 (0.50-0.60)], previous use of aspirin [0.78 (0.62-0.98)], and randomization to atorvastatin vs. placebo [0.87 (0.76-1.00)] significantly reduced the risk of resistant hypertension. Secondary analysis results were similar. The risk score developed allows accurate risk allocation (Harrell's C-statistic 0.71), with excellent calibration (Hosmer-Lemeshow χ statistics, P = 0.99). A 12-fold (8.4-17.4) increased risk among those in the highest vs. lowest risk deciles was apparent. CONCLUSION: Baseline SBP and choice of subsequent antihypertensive therapy were the two most important determinants of resistant hypertension in the ASCOT population. Individuals at high risk of developing resistant hypertension can be easily identified using an integer-based risk score.

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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 [22]

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Baseline predictors of resistant hypertension in the Anglo-Scandinavian Cardiac Outcome Trial (ASCOT): a risk score to identify those at high-risk
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Fokum, S. R. (2017) · DigitalCommons-IMSA (Illinois Mathematics and Science Academy)

Authors: Gupta, A. K., Nasothimiou, E. G., Chang, C. L., Sever, P. S., Dahlöf, B., & Poulter, N. R.
Affiliations: Imperial College London (GB)
Corresponding author: Gupta, Ajay K.
ORCID: Gupta, Ajay K.
Poulter, Neil R.
Venue: Journal of Hypertension
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2011-10
Volume: 29
Issue: 10
Pages: 2004-2013
ISSN: 0263-6352 (ISSN-L)
DOI: 10.1097/hjh.0b013e32834a8a42
OpenAlex: W2082072583
Cited by: 165
References: 26
Citations by year: 2026: 4 · 2025: 1 · 2024: 8 · 2023: 11 · 2022: 5 · 2021: 9 · 2020: 4 · 2019: 10 · 2018: 10 · 2017: 15 · 2016: 13 · 2015: 14 · 2014: 26 · 2013: 21 · 2012: 13
FWCI: 13.42
Type: journal article
Language: en
Open access: closed
Locations: Journal of Hypertension (publishedVersion)
PubMed (publishedVersion)
Funders: Pfizer
National Institute for Health and Care Research (NF-SI-0508-10116)
British Heart Foundation
Servier
National Institutes of Health
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, baseline predictors, risk score, systolic blood pressure, antihypertensive therapy, amlodipine, perindopril, atenolol, thiazide diuretics, atorvastatin, aspirin, diabetes mellitus, left ventricular hypertrophy, alcohol consumption, body mass index, hypertension incidence, ASCOT trial
MeSH terms: Aged, Algorithms, Antihypertensive Agents, Atenolol, Bendroflumethiazide, Diuretics, Drug Resistance, Female, United Kingdom, Humans, Hypertension, Ireland, Male, Middle Aged, Risk Factors, Scandinavian and Nordic Countries, Amlodipine, Perindopril

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Baseline predictors of resistant hypertension in the Anglo-Scandinavian Cardiac Outcome Trial (ASCOT): a risk score to identify those at high-risk

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