Cited by 930Blood Pressure and Hypertension StudiesCardiovascular Health and Disease PreventionHormonal Regulation and Hypertension

Incidence and Prognosis of Resistant Hypertension in Hypertensive Patients

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Daugherty, Stacie L., Powers, J. David, Magid, David J., Tavel, Heather M., Masoudi, Frederick A., Margolis, Karen L., O'Connor, Patrick J., Selby, Joe V. +1 more·2012·Circulation

Abstract

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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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...
Venue
Circulation
Published
2012-04-03
Volume
125
Issue
13
Pages
1635-1642
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
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
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

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