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Observational Study
. 2014 Feb 28;3(1):e000660.
doi: 10.1161/JAHA.113.000660.

Cardiovascular and mortality risk of apparent resistant hypertension in women with suspected myocardial ischemia: a report from the NHLBI-sponsored WISE Study

Steven M Smith  1 , Tianyao Huo, B Delia Johnson, Vera Bittner, Sheryl F Kelsey, Diane Vido Thompson, C Noel Bairey Merz, Carl J Pepine, Rhonda M Cooper-Dehoff
Affiliations
Observational Study

Cardiovascular and mortality risk of apparent resistant hypertension in women with suspected myocardial ischemia: a report from the NHLBI-sponsored WISE Study

Steven M Smith et al. J Am Heart Assoc. .

Abstract

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.

Keywords: WISE; hypertension; resistant hypertension; women.

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Figures

Figure 1.
Figure 1.
Kaplan‐Meier curve for primary outcome event‐free survival according to hypertension group. HTN indicates hypertension.
Figure 2.
Figure 2.
Kaplan‐Meier curve for survival from all‐cause death according to hypertension group. HTN indicates hypertension.
See this image and copyright information in PMC

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