Predictors and outcomes of resistant hypertension among patients with coronary artery disease and hypertension

医学 危险系数 内科学 冲程(发动机) 心肌梗塞 优势比 冠状动脉疾病 心脏病学 置信区间 糖尿病 曲多普利 血压 血管紧张素转换酶抑制剂 血管紧张素转换酶 工程类 内分泌学 机械工程
作者
Steven M. Smith,Yan Gong,Eileen Handberg,Franz H. Messerli,George L. Bakris,Ali Ahmed,Anthony A. Bavry,Carl J. Pepine,Rhonda M. Cooper‐DeHoff
出处
期刊:Journal of Hypertension [Lippincott Williams & Wilkins]
卷期号:32 (3): 635-643 被引量:109
标识
DOI:10.1097/hjh.0000000000000051
摘要

Objective: Resistant hypertension (res-HTN) is a challenging problem, but little is known of res-HTN in patients with coronary artery disease (CAD). In this post-hoc INternational VErapamil SR-Trandolapril STudy (INVEST) analysis, we assessed prevalence, predictors, and impact on outcomes of res-HTN in CAD patients with hypertension. Methods: Participants (n = 17 190) were divided into three groups according to achieved blood pressure (BP): controlled (BP <140/90 mmHg on three or fewer drugs); uncontrolled (BP ≥140/90 mmHg on two or fewer drugs); or resistant (BP ≥140/90 mmHg on three drugs or any patient on at least four drugs). Results: The prevalence of res-HTN was 38%: significant predictors of res-HTN included heart failure [odds ratio (OR) 1.73], diabetes (OR 1.63), Black race (OR 1.50), and US residence (OR 1.50). Compared with controlled HTN, res-HTN had multivariate-adjusted association with higher risk of adverse outcomes {first occurrence of all-cause death, nonfatal myocardial infarction, or nonfatal stroke [hazard ratio 1.27, 95% confidence interval (CI) 1.13–1.43], and individual outcomes of all-cause death (hazard ratio 1.29, 95% CI 1.13–1.48), cardiovascular mortality (hazard ratio 1.47, 95% CI 1.21–1.78), and nonfatal stroke (hazard ratio 1.61, 95% CI 1.17–2.22), but not nonfatal myocardial infarction (hazard ratio 0.98, 95% CI 0.72–1.34)}. Adverse outcomes, except nonfatal stroke, did not differ in patients with res-HTN compared to uncontrolled HTN. Conclusions: Res-HTN is common in patients with CAD and hypertension, associated with poor prognosis, and linked with a number of conditions. Emphasis should be placed on recognizing those at risk for res-HTN and future studies should examine whether more aggressive treatment of res-HTN improves outcomes.
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