Resistant Hypertension and Mortality: An Observational Cohort Study

医学 白大衣高血压 危险系数 内科学 动态血压 血压 隐匿性高血压 混淆 比例危险模型 抵抗性高血压 心脏病学 队列 置信区间
作者
Alejandro de la Sierra,Luís M. Ruilope,Natalie Staplin,Manuel Gorostidi,Ernest Vinyoles,J. Segura,Pedro Armario,Anna Oliveras,Bryan Williams
出处
期刊:Hypertension [Ovid Technologies (Wolters Kluwer)]
卷期号:81 (11): 2350-2356 被引量:1
标识
DOI:10.1161/hypertensionaha.124.23276
摘要

BACKGROUND: Resistant hypertension is characterized by elevated blood pressure (BP) despite using 3 antihypertensive agents. Ambulatory BP monitoring (ABPM) detects the presence of white-coat resistant hypertension (24-hour BP <130/80 mm Hg). The aim of the study was to evaluate risks of death in resistant hypertension compared with controlled hypertension, as well as in ABPM-confirmed (24-hour BP ≥130 or 80 mm Hg), versus white-coat resistant hypertension. METHODS: We selected 8146 patients with controlled hypertension (office BP <140/90 mm Hg while being treated with ≤3 antihypertensive drugs) and 8577 with resistant hypertension (BP ≥140 or ≥90 mm Hg while being treated with ≥3 drugs). All-cause and cardiovascular mortalities (median follow-up, 9.7 years) were compared between groups, as well as between patients with white-coat (3289) and ABPM-confirmed (5288) resistant hypertension. Hazard ratios (HRs) from Cox models after adjustment for clinical confounders were used for comparisons. RESULTS: Compared with controlled hypertension, resistant hypertension was associated with an increased risk in all-cause (HR, 1.21 [95% CI, 1.12–1.30]) and cardiovascular mortalities (HR, 1.33 [95% CI, 1.17–1.51]) in confounder-adjusted models. Compared with white-coat, ABPM-confirmed resistant hypertension was associated with an increased risk of all-cause (HR, 1.45 [95% CI, 1.32–1.60]) and cardiovascular (HR, 1.68 [95% CI, 1.43–1.98]) mortalities. When ABPM-confirmed and white-coat resistant hypertension were separately compared with controlled hypertension, only the former was associated with an increased risk of death and cardiovascular death (HR, 1.36 [95% CI, 1.26–1.48] and 1.56 [95% CI, 1.36–1.79]), respectively. CONCLUSIONS: ABPM-confirmed resistant hypertension is associated with an increased risk of death and cardiovascular death with respect to both controlled hypertension and white-coat resistant hypertension.
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