Cardiovascular and Mortality Risk of Apparent Resistant Hypertension in Women With Suspected Myocardial Ischemia: A Report From the NHLBI‐Sponsored WISE Study
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Background: Women are more likely than men to develop resistant hypertension, which is associated with excess risk of major adverse outcomes; however, the impact of resistant hypertension in women with ischemia has not been explicitly studied. In this Women's Ischemia Syndrome Evaluation ( WISE ) analysis, we assessed long‐term adverse outcomes associated with apparent treatment‐resistant hypertension ( aTRH ) among women with suspected myocardial ischemia referred for coronary angiography. Methods and Results: Women (n=927) were grouped according to baseline blood pressure ( BP ): normotensive (no hypertension history, BP <140/90 mm Hg, no antihypertensive drugs); controlled ( BP <140/90 mm Hg and a hypertension diagnosis or on 1 to 3 drugs); uncontrolled ( BP ≥140/90 mm Hg on ≤2 drugs); or aTRH ( BP ≥140/90 mm Hg on 3 drugs or anyone on ≥4 drugs). Adverse outcomes (first occurrence of death [any cause], nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure or angina) were collected over 10 years of follow‐up. Apparent treatment‐resistant hypertension prevalence was 10.4% among those with hypertension. Women with aTRH had a greater incidence of adverse outcomes, compared with normotensive women (adjusted hazard ratio [ HR], 3.25; 95% confidence interval [ CI], 1.94 to 5.43), and women with controlled ( HR, 1.77; 95% CI, 1.26 to 2.49) and uncontrolled ( HR, 1.62; 95% CI, 1.15 to 2.27) hypertension; outcome differences were evident early in follow‐up. Risk of all‐cause death was greater in the aTRH group, compared to the normotensive women and women with controlled and uncontrolled hypertension. Conclusions: In this cohort of women with evidence of ischemia, aTRH was associated with a profoundly increased long‐term risk of major adverse events, including death, that emerged early during follow‐up.
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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 [34]
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- Authors
- Smith, S. M., Huo, T., Delia Johnson, B., Bittner, V., Kelsey, S. F., Vido Thompson, D., Noel Bairey Merz, C., Pepine, C. J., & Cooper‐DeHoff, R. M.
- Affiliations
- University of Florida (US)
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
- University of Alabama at Birmingham (US)
- University of Pittsburgh (US)
- Allegheny General Hospital, Pittsburgh, PA
- Barbara Streisand Women's Heart Center, Cedars‐Sinai Heart Institute, Los Angeles, CA
- Venue
- Journal of the American Heart Association
- Published
- 2014-01-27
- Volume
- 3
- Issue
- 1
- Pages
- e000660-e000660
- ISSN
- 2047-9980 (ISSN-L)
- PMC
- PMC3959684
- OpenAlex
- W2125594639
- Cited by
- 69
- References
- 45
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 6 · 2023: 7 · 2022: 4 · 2021: 7 · 2020: 8 · 2019: 3 · 2018: 9 · 2017: 6 · 2016: 8 · 2015: 6 · 2014: 3
- FWCI
- 5.26
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- Journal of the American Heart Association (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (n01hv068164-006, n01hv068162-009, n01hv068161-005, UL1TR000124, n01hv068163-006)
- U.S. Public Health Service (U0164829)
- National Institute on Aging (R03AG032631)
- National Heart, Lung, and Blood Institute (U01HL064829, N01-HV68162, N01 HV 68161, U01HL649141, T32HL069751, N01HV68163, U01 HL649241, T32HL69751, R01HL090957, N01-HV68164)
- National Center for Research Resources (M01RR000425, M01-RR00425)
- National Center for Advancing Translational Sciences
- 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
- apparent treatment-resistant hypertension, women, myocardial ischemia, coronary artery disease, cardiovascular risk, mortality, major adverse cardiovascular events, all-cause mortality, myocardial infarction, stroke, heart failure, angina pectoris, antihypertensive therapy, WISE study
- MeSH terms
- Adult, Aged, Angina Pectoris, Antihypertensive Agents, Blood Pressure, Drug Resistance, Drug Therapy, Combination, Female, Heart Failure, Hospitalization, Humans, Hypertension, Middle Aged, Myocardial Infarction, Prognosis, Risk Factors, Sex Factors, Time Factors, United States, Proportional Hazards Models, Coronary Angiography, Myocardial Ischemia, Stroke, Kaplan-Meier Estimate, National Heart, Lung, and Blood Institute (U.S.)
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