Blood Pressure Control Provides Less Cardiovascular Protection in Adults With Than Without Apparent Treatment‐Resistant Hypertension
Open accessAbstract
Hypertension control may offer less protection from incident cardiovascular disease (CVDi) in adults with than without apparent treatment‐resistant hypertension (aTRH), ie, blood pressure uncontrolled while taking three or more antihypertensive medications or controlled to <140/<90 mm Hg while taking four or more antihypertensive medications. Electronic health data were matched to health claims for 2006–2012. Patients with CVDi in 2006–2007 or with untreated hypertension were excluded, leaving 118,356 treated hypertensives, including 40,690 with aTRH, and 460,599 observation years. Blood pressure and medication number were determined by all clinic visit means from 2008 to CVDi or end of study. Primary outcome was first CVDi (stroke, coronary heart disease, heart failure) from hospital and emergency department claims. Controlling for age, race, sex, diabetes, chronic kidney disease, and statin use, hypertension control afforded less CVDi protection in patients with aTRH (hazard ratio, 0.87; 95% confidence interval, 0.82–0.93) than without aTRH (hazard ratio, 0.69; 95% confidence interval, 0.65–0.74; P<.001). Strategies beyond hypertension control may prevent more CVDi in patients with aTRH.
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In another study of more than 118,000 treated hypertensive adults, blood pressure control was associated with significantly lower rates of incident stroke and coronary heart disease with no difference in rates of incident heart failure.
“In another study of >118 000 treated hypertensive adults, including >40 000 individuals with RH and 460 000 observation-years, BP control was associated with significantly lower rates of incident stroke and coronary heart disease with no difference in rates of incident heart failure.37”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [37]
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 [37]
Blood pressure control reduced the risk of incident stroke, coronary heart disease, or heart failure by 13% among those with resistant hypertension compared with a 31% lower risk of these outcomes among patients without resistant hypertension.
“BP control reduced the risk of incident stroke, coronary heart disease, or heart failure by 13% among those with RH compared with a 31% lower risk of these outcomes among patients without RH.37”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [37]
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- Authors
- Egan, B. M., Kai, B., Wagner, C. S., Henderson, J. H., Chandler, A. H., & Sinopoli, A.
- Affiliations
- Prisma Health (US)
- College of Charleston (US)
- University of South Carolina (US)
- Corresponding author
- Egan, Brent M.
- Venue
- The Journal of Clinical Hypertension
- Publisher
- Wiley
- Published
- 2016-02-09
- Volume
- 18
- Issue
- 8
- Pages
- 817-824
- ISSN
- 1524-6175 (ISSN-L)
- 1751-7176
- PMC
- PMC5837039
- OpenAlex
- W2253820963
- Cited by
- 32
- References
- 46
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 3 · 2023: 5 · 2022: 3 · 2021: 2 · 2020: 4 · 2019: 3 · 2018: 5 · 2017: 2 · 2016: 1
- FWCI
- 3.02
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Clinical Hypertension (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Medtronic
- National Institutes of Health (HL105880)
- Centers for Disease Control and Prevention
- 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
- treatment-resistant hypertension, blood pressure control, cardiovascular disease incidence, antihypertensive medication burden, cardioprotection, stroke, coronary artery disease, heart failure, hypertension
- MeSH terms
- Adult, Antihypertensive Agents, Blood Pressure, Blood Pressure Determination, Cardiovascular Diseases, Emergency Medical Services, Female, Humans, Hypertension, Male, Middle Aged, Risk Factors, Prevalence, Treatment Failure
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