Resistant Hypertension, Patient Characteristics, and Risk of Stroke
Open accessAbstract
BACKGROUND: Little is known about the prognosis of resistant hypertension (RH) in Asian population. This study aimed to evaluate the impacts of RH in Taiwanese patients with hypertension, and to ascertain whether patient characteristics influence the association of RH with adverse outcomes. METHODS AND RESULTS: Patients aged ≥45 years with hypertension were identified from the National Health Insurance Research Database. Medical records of 111,986 patients were reviewed in this study, and 16,402 (14.6%) patients were recognized as having RH (continuously concomitant use of ≥3 anti-hypertensive medications, including a diuretic, for ≥2 years). Risk of major adverse cardiovascular events (MACE, a composite of all-cause mortality, acute coronary syndrome, and stroke [included both fatal and nonfatal events]) in patients with RH and non-RH was analyzed. A total of 11,856 patients experienced MACE in the follow-up period (average 7.1±3.0 years). There was a higher proportion of females in the RH group, they were older than the non-RH (63.1 vs. 60.5 years) patients, and had a higher prevalence of cardiovascular co-morbidities. Overall, patients with RH had higher risks of MACE (adjusted HR 1.17; 95%CI 1.09-1.26; p<0.001). Significantly elevated risks of stroke (10,211 events; adjusted HR 1.17; 95%CI 1.08-1.27; p<0.001), especially ischemic stroke (6,235 events; adjusted HR 1.34; 95%CI 1.20-1.48; p<0.001), but not all-cause mortality (4,594 events; adjusted HR 1.06; 95%CI 0.95-1.19; p = 0.312) or acute coronary syndrome (2,145 events; adjusted HR 1.17; 95%CI 0.99-1.39; p = 0.070) were noted in patients with RH compared to those with non-RH. Subgroup analysis showed that RH increased the risks of stroke in female and elderly patients. However, no significant influence was noted in young or male patients. CONCLUSIONS: Patients with RH were associated with higher risks of MACE and stroke, especially ischemic stroke. The risks were greater in female and elderly patients than in male or young patients.
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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 [27]
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- Authors
- Hung, C.-Y., Wang, K.-Y., Wu, T.-J., Hsieh, Y.-C., Huang, J.-L., Loh, E.-W., & Lin, C.-H.
- Affiliations
- Taipei Veterans General Hospital (TW)
- Taichung Veterans General Hospital (TW)
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital (TW)
- Corresponding author
- Wang, Kuo-Yang
- Lin, Ching-Heng
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2014-08-04
- Volume
- 9
- Issue
- 8
- Pages
- e104362
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC4121289
- OpenAlex
- W1976394772
- Cited by
- 27
- References
- 28
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 1 · 2023: 3 · 2022: 1 · 2021: 2 · 2020: 3 · 2019: 1 · 2018: 4 · 2017: 3 · 2016: 3 · 2015: 3
- FWCI
- 2.06
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- National Health Research Institutes
- Taichung Veterans General Hospital (TCVGH-1027308C)
- 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, stroke, ischemic stroke, major adverse cardiovascular events, hypertension, patient characteristics, sex differences, elderly patients, cardiovascular comorbidity, Taiwanese patients, prognosis, all-cause mortality, acute coronary syndrome, Asian populations, subgroup analysis, cardiovascular risk stratification
- MeSH terms
- Aged, Aged, 80 and over, Antihypertensive Agents, Female, Humans, Hypertension, Male, Middle Aged, Myocardial Infarction, Prognosis, Comorbidity, Risk Assessment, Stroke, Asian People, Drug-Related Side Effects and Adverse Reactions
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