Resistant arterial hypertension was associated with a higher rate of the composite cardiovascular endpoint compared to controlled hypertension over 5 years (30.8% vs 7.0%, P=0.001).
Cohort (n=236)
Does resistant arterial hypertension and elevated baseline biomarkers increase the risk of cardiovascular and renal complications compared to controlled hypertension?
Resistant arterial hypertension is associated with a four-fold increased risk of major cardiovascular and renal complications over 5 years compared to controlled hypertension, with elevated citrulline and systolic blood pressure serving as independent prognostic markers.
Absolute Event Rate: 30.8% vs 7%
p-value: p=0.001
Objective: To determine the markers of disease progression, the risk of cardiovascular complications in patients with RAH. Design and method: Patients with RAH (122) and with controlled hypertension (114) were examined. At the beginning and after 5 years of observation an ABPM, echocardiography were performed. GFR was determined by cystatin-C, TNF-α, interleukin-6 (IL-6)- by the immunoenzymatic, citrulline content - by spectrophotometric, C-reactive protein (CRP) - by immunoturbidometric method. Results: Higher baseline values of citrulline (OR = 1.07; 95% CI: 1.03 – 1.10), cystatin C (OR = 1.81; 95% CI: 1.22 – 2.68), TNF-α (OR = 2.18; 95% CI: 1.15 – 4.13), daily albuminuria (OR = 1.01; 95% CI: 1.00 – 1.01), BMI (OR = 1.17; 95% CI: 1.03 – 1.32) and lower baseline GFR (HR = 0.96; 95% CI: 0.93 – 0.99) and low adherence to therapy (HR = 2.63; 95% CI: 1.11 – 6.21) are associated with an unfavorable prognosis in RAH pts after 5 years of follow-up. Independent factors increasing the relative risk of the composite endpoint (MI, myocardial revascularization, stroke/TIA, atrial fibrillation, hospitalization for heart failure, decrease in GFR by > 40% or hemodialysis) - are concentration of citrulline > 68 μmol/l (HR 1.13; 95% CI (1.07–1.20); p 163 mm Hg (HR 1.10; 95% CI (1.03–1.18); p=0.008). The frequency of composite endpoint cases in RAH pts is 4 times higher than in the group of patients with controlled hypertension: 30.8% (36/117) versus 7.0% (8/114), (P = 0.001). Violations of carbohydrate metabolism occur 4.7 times more often in RAH compared to controlled hypertension pts (8.5 vs. 1.8%, P = 0.03). Conclusions: In RAH pts an increase in the relative risk of the occurrence of the composite endpoint 4 times compared to controlled hypertension was shown. Independent factors of the increase in the relative risk of the combined endpoint are the initial concentration of citrulline in the blood > 68 μmol/l and average daily SBP > 163 mm Hg.
Bezrodna et al. (Fri,) conducted a cohort in Resistant arterial hypertension (n=236). Resistant arterial hypertension vs. Controlled hypertension was evaluated on Composite endpoint (MI, myocardial revascularization, stroke/TIA, atrial fibrillation, hospitalization for heart failure, decrease in GFR by > 40% or hemodialysis) (p=0.001). Resistant arterial hypertension was associated with a higher rate of the composite cardiovascular endpoint compared to controlled hypertension over 5 years (30.8% vs 7.0%, P=0.001).