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Comparative Study
. 2015 Sep;88(3):622-32.
doi: 10.1038/ki.2015.142. Epub 2015 May 6.

Comparative risk of renal, cardiovascular, and mortality outcomes in controlled, uncontrolled resistant, and nonresistant hypertension

John J Sim  1 , Simran K Bhandari  1 , Jiaxiao Shi  2 , Kristi Reynolds  2 , David A Calhoun  3 , Kamyar Kalantar-Zadeh  4 , Steven J Jacobsen  2
Affiliations
Comparative Study

Comparative risk of renal, cardiovascular, and mortality outcomes in controlled, uncontrolled resistant, and nonresistant hypertension

John J Sim et al. Kidney Int. 2015 Sep.

Abstract

We sought to compare the risk of end-stage renal disease (ESRD), ischemic heart event (IHE), congestive heart failure (CHF), cerebrovascular accident (CVA), and all-cause mortality among 470,386 individuals with resistant and nonresistant hypertension (non-RH). Resistant hypertension (60,327 individuals) was subcategorized into two groups: 23,104 patients with cRH (controlled on four or more medicines) and 37,223 patients with uRH (uncontrolled on three or more medicines) in a 5-year retrospective cohort study. Cox proportional hazard modeling was used to estimate hazard ratios adjusting for age, gender, race, body mass index, chronic kidney disease (CKD), and comorbidities. Resistant hypertension (cRH and uRH), compared with non-RH, had multivariable adjusted hazard ratios (95% confidence intervals) of 1.32 (1.27-1.37), 1.24 (1.20-1.28), 1.46 (1.40-1.52), 1.14 (1.10-1.19), and 1.06 (1.03-1.08) for ESRD, IHE, CHF, CVA, and mortality, respectively. Comparison of uRH with cRH had hazard ratios of 1.25 (1.18-1.33), 1.04 (0.99-1.10), 0.94 (0.89-1.01), 1.23 (1.14-1.31), and 1.01 (0.97-1.05) for ESRD, IHE, CHF, CVA, and mortality, respectively. Men and Hispanics had a greater risk for ESRD within all three cohorts. Individuals with resistant hypertension had a greater risk for ESRD, IHE, CHF, CVA, and mortality. The risk of ESRD and CVA were 25% and 23% greater, respectively, in uRH compared with cRH, supporting the linkage between blood pressure and both outcomes.

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Conflict of interest statement

Disclosure

No other authors have any conflicts of interest relevant to this manuscript.

Figures

Figure 1
Figure 1
Among approximately 2.4 million adult KPSC members, 470,386 individuals were identified with hypertension. Resistant hypertension was identified in 60,327 (12.8%) with 4.9% controlled resistant hypertension (cRH) and 7.9% uncontrolled resistant hypertension (uRH).
Figure 2
Figure 2
The use of antihypertensive medication classes among the study cohort within each hypertension group: non-resistant hypertension (non-RH), controlled resistant hypertension (cRH), and uncontrolled resistant hypertension (uRH). Diuretics and renin angiotensin system blockers were the most frequently prescribed.
Figure 3
Figure 3
Multivariable adjusted hazard ratio (95% confidence interval) for ischemic heart event, congestive heart failure, cerebrovascular accident, end stage renal disease, and all-cause mortality in subjects with: (a) RH (cRH + uRH) in comparison to those with non-RH (b) cRH vs non-RH (c) uRH vs non-RH and (d) uRH vs cRH.
Figure 4
Figure 4
Kaplan Meier survival curves for the primary endpoints (a) ischemic heart event (b) cerebrovascular accident (c) congestive heart failure (d) end stage renal disease (e) all-cause mortality and (f) combined events in patients with non-resistant hypertension (non-RH) and resistant hypertension (RH) which includes both uncontrolled (uRH) and controlled resistant hypertension (cRH).
Figure 5
Figure 5
For mortality, use of ACEI, ARB, and thiazide type diuretics were all associated with lower risk amongst the different hypertension sub groups.
See this image and copyright information in PMC

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