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Resistant Hypertension and Mortality: An Observational Cohort Study
Alejandro de la Sierra1, Luis M Ruilope2, Natalie Staplin3
1Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Terrassa, Spain (A.d.l.S.).
Hypertension (Dallas, Tex. : 1979)
|September 9, 2024
Summary
Resistant hypertension, especially when confirmed by ambulatory blood pressure monitoring (ABPM), significantly increases the risk of all-cause and cardiovascular death compared to controlled hypertension.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Outcomes
Background:
- Resistant hypertension (RH) is defined as elevated blood pressure (BP) despite three antihypertensive agents.
- Ambulatory BP monitoring (ABPM) can distinguish true RH from white-coat RH.
- The prognostic implications of ABPM-confirmed RH versus white-coat RH require further clarification.
Purpose of the Study:
- To compare all-cause and cardiovascular mortality risks between patients with controlled hypertension and resistant hypertension.
- To evaluate the differential mortality risks between ABPM-confirmed resistant hypertension and white-coat resistant hypertension.
Main Methods:
- A cohort study involving 8146 patients with controlled hypertension and 8577 with resistant hypertension.
- Patients were categorized into white-coat RH (n=3289) and ABPM-confirmed RH (n=5288) groups.
- Cox models were used to compare all-cause and cardiovascular mortality after adjusting for confounders over a median follow-up of 9.7 years.
Main Results:
- Resistant hypertension was associated with increased all-cause (HR 1.21) and cardiovascular mortality (HR 1.33) versus controlled hypertension.
- ABPM-confirmed RH showed higher risks of all-cause (HR 1.45) and cardiovascular mortality (HR 1.68) compared to white-coat RH.
- Only ABPM-confirmed RH, not white-coat RH, was linked to significantly increased mortality compared to controlled hypertension.
Conclusions:
- ABPM-confirmed resistant hypertension carries a significantly higher risk of mortality than white-coat resistant hypertension.
- Accurate diagnosis of resistant hypertension using ABPM is crucial for risk stratification and management.
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