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Association of treatment-resistant hypertension defined by home blood pressure monitoring with cardiovascular outcome

Hypertension Research volume 45, pages 75–86 (2022)Cite this article

A Comment to this article was published on 18 November 2021

Abstract

In diagnosis of treatment-resistant hypertension (TRH), guidelines recommend out-of-office blood pressure (BP) measurements, ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM). Although evidence of an association between ABPM-evaluated TRH and cardiovascular disease (CVD) prognosis has accumulated, data are sparse regarding HBPM-evaluated TRH. We investigated this issue using data from the nationwide practice-based J-HOP (Japan Morning-Surge Home BP) study, which recruited 4,261 outpatients (mean age 64.9 years; 46.8% men; 91.5% hypertensives) who underwent morning and evening HBPM for 14 days. During 6.2 ± 3.8 years (26,418 person-years) follow-up, 270 total CVDs (stroke, coronary artery disease, aortic dissection, and heart failure) occurred. The adjusted hazard ratio (HR) (95% CIs) of uncontrolled TRH, i.e., uncontrolled BP using 3 classes of medications including diuretics or ≥4 classes of medications, for total CVD risk compared to controlled BP using <3 classes were 2.02 (1.38–2.94) and 1.81 (1.23–2.65) in home BP of 135/85 mmHg and 130/80 mmHg, respectively. Additionally, patients with TRH defined by guidelines, i.e., uncontrolled BP using 3 classes of medications including diuretics or controlled/uncontrolled BP using ≥4 classes of medications, also had higher total CVD risk compared to non-TRH under all home BP criteria. Moreover, in patients with uncontrolled apparent-TRH, i.e., TRH defined by office BP, uncontrolled home BP (≥135/85 mmHg) was still associated with atherosclerotic CVD (CVDs except heart failure) risk (adjusted HR [95% CI], 2.38 [1.09–5.19]). This is the first study to demonstrate an independent association between TRH evaluated by HBPM and CVD outcomes.

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Acknowledgements

We gratefully acknowledge the numerous study investigators and participants in the J-HOP study.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan

    Keisuke Narita, Satoshi Hoshide & Kazuomi Kario

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Contributions

Kario K takes primary responsibility for this paper. Narita K analyzed the data and performed the literature research, writing the paper. Kario K and Hoshide S collected the patients’ data. All authors conceived and designed the entire study and reviewed/edited the manuscript.

Funding information

This study was financially supported, in part, by a grant from the 21st Century Center of Excellence Project run by Japan’s Ministry of Education, Culture, Sports, Science, and Technology (MEXT); a grant from the Foundation for Development of the Community (Tochigi); a grant from Omron Healthcare Co., Ltd.; a Grant-in-Aid for Scientific Research (B; 21390247) from The Ministry of Education, Culture, Sports, Science, and Technology of Japan, 2009 to 2013; and funds from the MEXT-supported program for the Strategic Research Foundation at Private Universities, 2011–2015 Cooperative Basic and Clinical Research on Circadian Medicine (S1101022) to KK. Funding sponsors had no role in the design or performance of the study; in the collection, management, analysis, or interpretation of the data; in the preparation of the article; or in the decision to submit the article for publication.

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Correspondence to Kazuomi Kario.

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KK received research funding from Omron Healthcare Co., Fukuda Denshi, and A&D Co. The other authors declare no competing interests.

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Narita, K., Hoshide, S. & Kario, K. Association of treatment-resistant hypertension defined by home blood pressure monitoring with cardiovascular outcome. Hypertens Res 45, 75–86 (2022). https://doi.org/10.1038/s41440-021-00757-4

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