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Cardiovascular morbidity of severe resistant hypertension among treated uncontrolled hypertensives: a 4-year follow-up study

Journal of Human Hypertension volume 32, pages 487–493 (2018)Cite this article

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Abstract

Data regarding the prognosis of resistant hypertension (RHTN) with respect to its severity is limited. We investigated the cardiovascular risk of severe RHTN in a prospective observational study. A cohort of 1700 hypertensive patient with treated uncontrolled HTN was followed for a mean period of 3.6 ± 1.8 years. At baseline, standard clinical and laboratory workup was performed, including testing for secondary causes of RHT where applicable. Three groups were identified depending on presence of RHTN (office-based uncontrolled HTN under at least three drugs including a diuretic) and levels of office systolic blood pressure (BP): 1187 patients (70%) without RHTN, 313 (18%) with not-severe RHTN (systolic BP < 160 mmHg) and 200 (12%) with severe RHTN (systolic BP ≥ 160 mmHg). Endpoint of interest was cardiovascular morbidity set as the composite of coronary heart disease and stroke. During follow-up, incidence rates of cardiovascular events per 1000 person-years were 7.1 cases in the non-RHTN group, 12.4 cases in the not-severe RHTN group and 18 cases in the severe RHTN group. Unadjusted analysis showed that compared to uncontrolled patients without RHTN, patients with not-severe RHTN exhibited a similar risk but patients with severe RHTN had a significantly higher risk, by 2.5 times (CI: 1.28–4.73, p = 0.007). Even after multivariate adjustment for established risk factors including BP levels and isolated systolic HTN, severe RHTN remained as an independent predictor of the cardiovascular outcome (OR: 2.30, CI: 1.00–5.29, p = 0.05). In conclusion, among treated yet uncontrolled hypertensive patients, severe RHTN exhibits a significantly higher cardiovascular risk indicating the need for prompt management.

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Authors and Affiliations

  1. First Cardiology Clinic, Medical School University of Athens, Hippokration Hospital, Athens, Greece

    Alexandros Kasiakogias, Costas Tsioufis, Kyriakos Dimitriadis, Dimitrios Konstantinidis, Areti Koumelli, Ioannis Leontsinis, Eirini Andrikou, Nikos Vogiatzakis, Christos Fragoulis, Konstantinos Konstantinou & Dimitrios Tousoulis

  2. Nephrology Department and Renal Transplantation Unit, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece

    Smaragdi Marinaki

  3. Department of Nephrology, Hippokration Hospital, Athens, Greece

    Dimitrios Petras

  4. VA and Georgetown University Medical Centers, Washington, DC, USA

    Vasilios Papademetriou

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  1. Alexandros Kasiakogias
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Correspondence to Costas Tsioufis.

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Kasiakogias, A., Tsioufis, C., Dimitriadis, K. et al. Cardiovascular morbidity of severe resistant hypertension among treated uncontrolled hypertensives: a 4-year follow-up study. J Hum Hypertens 32, 487–493 (2018). https://doi.org/10.1038/s41371-018-0065-y

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