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Prevalence, predictors, and outcomes in treatment-resistant hypertension in patients with coronary disease
Sripal Bangalore1, Rana Fayyad2, Rachel Laskey2
1New York University School of Medicine, New York, NY.
Insights
Apparent treatment-resistant hypertension in coronary artery disease patients significantly elevates cardiovascular risks. This condition is linked to increased major cardiovascular events, coronary heart disease death, and myocardial infarction.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Outcomes
Background:
- Apparent treatment-resistant hypertension (aTRH) is increasingly recognized but poorly understood.
- Prevalence, predictors, and outcomes of aTRH are largely unknown, particularly in patients with coronary artery disease (CAD).
Purpose of the Study:
- To investigate the prevalence, predictors, and cardiovascular outcomes of aTRH in patients with established CAD.
- To determine the association between aTRH and major adverse cardiovascular events (MACE).
Main Methods:
- Evaluation of 10,001 patients with CAD from the Treating to New Targets trial.
- aTRH defined as blood pressure (BP) ≥140 mmHg despite 3 antihypertensive agents or BP <140 mmHg with ≥4 agents.
- Primary outcome: MACE (composite of fatal coronary heart disease, nonfatal myocardial infarction, resuscitated cardiac arrest, stroke).
Main Results:
- 11.1% of patients had aTRH.
- aTRH was associated with a 64% increased risk of MACE (HR, 1.64; 95% CI, 1.39-1.94; P < .001).
- Significant increases observed in coronary heart disease death (69%), nonfatal myocardial infarction (73%), all-cause death (45%), and heart failure (33%).
Conclusions:
- aTRH is a significant risk factor for cardiovascular morbidity and mortality in patients with CAD.
- The findings highlight the importance of recognizing and managing aTRH to improve patient outcomes.
- aTRH is associated with a marked increase in cardiovascular events and all-cause mortality.
Background:
Increasingly, apparent treatment-resistant hypertension has been recognized. However, much of the prevalence, predictors, and outcomes are largely unknown, especially in patients with coronary artery disease.
Methods:
We evaluated 10,001 patients with coronary artery disease who were enrolled in the Treating to New Targets trial. Apparent treatment-resistant hypertension was defined as blood pressure ≥ 140 mm Hg despite 3 antihypertensive agents or <140 mm Hg with ≥ 4 antihypertensive agents. The primary outcome was major cardiovascular events (composite of fatal coronary heart disease, nonfatal myocardial infarction, resuscitated cardiac arrest, and stroke).
Results:
Among the 10,001 patients in the trial, 1112 (11.1%) had apparent treatment-resistant hypertension. In a multivariable model adjusting for baseline differences, the treatment-resistant hypertension group had a 64% increase in primary outcome (hazard ratio [HR], 1.64; 95% confidence interval [CI], 1.39-1.94; P < .001), driven by a 69% increase in coronary heart disease death (HR, 1.69; 95% CI, 1.22, 2.34; P = .001) and 73% increase in nonfatal myocardial infarction (HR, 1.73; 95% CI, 1.39-2.16, P < .0001) when compared with the no apparent treatment-resistant hypertension group. In addition, patients with apparent treatment-resistant hypertension had a 71% increase in major coronary event (P < .0001), 45% increase in death (P = .001), 33% increase in heart failure (P = .05), 53% increase in any cardiovascular event (P < .0001), 60% increase in any coronary event (P < .0001), 68% increase in angina (P < .0001), and 51% increase in coronary revascularization (P < .0001) when compared with the no apparent treatment-resistant hypertension group. Results were largely similar whether the definition of apparent treatment-resistant hypertension was based on a blood pressure ≥ 140 mm Hg despite 3 agents or a blood pressure <140 mm Hg with ≥ 4 agents.
Conclusions:
In patients with coronary artery disease, apparent treatment-resistant hypertension is associated with a marked increase in the risk of cardiovascular morbidity and mortality, including an increase in all-cause death.
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