Incidence and Prognosis of Resistant Hypertension in Hypertensive Patients
Open accessAbstract
Background—: Despite a recent American Heart Association (AHA) consensus statement emphasizing the importance of resistant hypertension, the incidence and prognosis of this condition are largely unknown. Methods and Results—: This retrospective cohort study in 2 integrated health plans included patients with incident hypertension in whom treatment was begun between 2002 and 2006. Patients were followed up for the development of resistant hypertension based on AHA criteria of uncontrolled blood pressure despite use of ≥3 antihypertensive medications, with data collected on prescription filling information and blood pressure measurement. We determined incident cardiovascular events (death or incident myocardial infarction, heart failure, stroke, or chronic kidney disease) in patients with and without resistant hypertension with adjustment for patient and clinical characteristics. Among 205 750 patients with incident hypertension, 1.9% developed resistant hypertension within a median of 1.5 years from initial treatment (0.7 cases per 100 person-years of follow-up). These patients were more often men, were older, and had higher rates of diabetes mellitus than nonresistant patients. Over 3.8 years of median follow-up, cardiovascular event rates were significantly higher in those with resistant hypertension (unadjusted 18.0% versus 13.5%, P <0.001). After adjustment for patient and clinical characteristics, resistant hypertension was associated with a higher risk of cardiovascular events (hazard ratio, 1.47; 95% confidence interval, 1.33–1.62). Conclusions—: Among patients with incident hypertension in whom treatment was begun, 1 in 50 patients developed resistant hypertension. Patients with resistant hypertension had an increased risk of cardiovascular events, which supports the need for greater efforts toward improving hypertension outcomes in this population.
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In a retrospective study of more than 200,000 patients with incident hypertension, those with resistant hypertension were 47% more likely to suffer the combined outcomes of death, myocardial infarction, heart failure, stroke, or chronic kidney disease over the median 3.8 years of follow-up.
“In a retrospective study of >200 000 patients with incident hypertension, those with RH were 47% more likely to suffer the combined outcomes of death, myocardial infarction, heart failure, stroke, or CKD over the median 3.8 years of follow-up.23”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [23]
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 [23]
In that retrospective study, differences in cardiovascular disease events were driven largely by a higher risk for the development of chronic kidney disease.
“Differences in CVD events in this study were driven largely by a higher risk for the development of CKD.23”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [23]
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 [23]
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- Authors
- Daugherty, S. L., Powers, J. D., Magid, D. J., Tavel, H. M., Masoudi, F. A., Margolis, K. L., O'Connor, P. J., Selby, J. V., & Ho, P. M.
- Affiliations
- Kaiser Permanente (US)
- From the University of Colorado Denver, Aurora, CO (S.L.D., D.J.M., F.A.M., P.M.H.); Institute for Health Research, Kaiser Permanente of Colorado, Denver, CO (S.L.D., J.D.P., D.J.M., H.M.T., F.A.M., P.M.H.); Denver Health Medical Center, Denver, CO (F.A.M.); Health Partners Research Foundation, Minneapolis, MN (K.L.M., P.J.O.); Kaiser Permanente of Northern California, Division of Research, Oakland, CA (J.V.S.); Patient Centered Outcomes Research Institute, Washington, DC (J.V.S.); and VA Medical...
- ORCID
- Venue
- Circulation
- Published
- 2012-04-03
- Volume
- 125
- Issue
- 13
- Pages
- 1635-1642
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- PMC
- PMC3343635
- OpenAlex
- W2089259727
- Cited by
- 930
- References
- 30
- Citations by year
- 2026: 41 · 2025: 38 · 2024: 48 · 2023: 55 · 2022: 55 · 2021: 55 · 2020: 65 · 2019: 57 · 2018: 56 · 2017: 63 · 2016: 88 · 2015: 80 · 2014: 104 · 2013: 93 · 2012: 29
- FWCI
- 62.19
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Heart, Lung, and Blood Institute (U19 HL91179-01, K08HL103776, U19HL091179)
- 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, hypertension, incidence, cardiovascular events, prognosis, antihypertensive therapy, uncontrolled hypertension, cardiovascular risk, diabetes mellitus, heart failure, stroke, myocardial infarction, chronic kidney disease
- MeSH terms
- Female, Follow-Up Studies, Humans, Hypertension, Male, Middle Aged, Prognosis, Retrospective Studies, Cohort Studies, Incidence
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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