Apparent treatment-resistant hypertension and risk for stroke, coronary heart disease, and all-cause mortality

Abstract

Apparent treatment-resistant hypertension (aTRH) is defined as uncontrolled hypertension despite the use of three or more antihypertensive medication classes or controlled hypertension while treated with four or more antihypertensive medication classes. We evaluated the association of aTRH with incident stroke, coronary heart disease (CHD), and all-cause mortality. Participants from the population-based REasons for Geographic And Racial Differences in Stroke (REGARDS) Study treated for hypertension with aTRH (n = 2043) and without aTRH (n = 12,479) were included. aTRH was further categorized as controlled aTRH (≥4 medication classes and controlled hypertension) and uncontrolled aTRH (≥3 medication classes and uncontrolled hypertension). Over a median of 5.9, 4.4, and 6.0 years of follow-up, the multivariable adjusted hazard ratio for stroke, CHD, and all-cause mortality associated with aTRH versus no aTRH was 1.25 (0.94-1.65), 1.69 (1.27-2.24), and 1.29 (1.14-1.46), respectively. Compared with controlled aTRH, uncontrolled aTRH was associated with CHD (hazard ratio, 2.33; 95% confidence interval, 1.21-4.48), but not stroke or mortality. Comparing controlled aTRH with no aTRH, risk of stroke, CHD, and all-cause mortality was not elevated. aTRH was associated with an increased risk for coronary heart disease and all-cause mortality.

Keywords: Resistant hypertension; antihypertensives; outcomes; severe hypertension.

Figure 1

Incidence rates of stroke, coronary heart disease, and all-cause mortality among REGARDS participants with and without apparent treatment resistant hypertension. aTRH = apparent treatment resistant hypertension; systolic blood pressure ≥ 140 mm Hg or diastolic blood pressure ≥ 90 mm Hg with ≥ 3 antihypertensive medication classes (uncontrolled aTRH) or systolic blood pressure < 140 mmHg and diastolic blood pressure< 90 mm Hg and treatment with ≥ 4 antihypertensive medication classes (controlled aTRH). No aTRH = no apparent treatment resistant hypertension; systolic blood pressure < 140 mmHg and diastolic blood pressure< 90 mm Hg while treated with < 4 antihypertensive medication classes or systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mm Hg while treated with 1 or 2 antihypertensive medication classes. Bar represents incidence rate, line represents 95% confidence interval. See Supplemental Table 2 for the incidence rates and 95% confidence intervals.