Resistant hypertension, defined by either the 2008 (≥140/90 mm Hg) or 2018 (≥130/80 mm Hg) AHA criteria, was significantly associated with increased risk of MACEs and renal events.
Cohort (n=2,018)
Does the 2018 AHA definition of apparent treatment-resistant hypertension predict MACE and renal events similarly to the 2008 definition in high-risk hypertension patients?
The updated 2018 AHA definition of resistant hypertension (BP ≥ 130/80 mm Hg) is a significant predictor of MACEs and renal events, supporting its adoption in clinical practice.
Resistant hypertension was defined according to the 2008 scientific statement as office blood pressure ≥ 140/90 mm Hg and the 2018 scientific statement as office blood pressure ≥ 130/80 mm Hg. We investigated the prognostic significance of lowered blood pressure threshold for defining resistant hypertension in the 2018 American Heart Association scientific statement compared with that in the 2008 scientific statement. The participants of this prospective cohort were enrolled from December 2013 to November 2018. Major adverse cardiovascular events (MACEs) were defined as a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, and heart failure hospitalization. Renal event was defined as a ≥ 50% decline in estimated glomerular filtration rate or progression to end-stage renal disease. A total of 206 patients among 2018 (10.2%) were diagnosed with resistant hypertension by the previous definition (≥140/90 mm Hg), and 276 patients among 2011 (13.7%) were diagnosed with resistant hypertension by the updated definition (≥130/80 mm Hg). During a median follow-up of 4.5 years, 33 MACEs (3.7 per 1000 patient-years) and 164 renal events (19.9 per 1000 patient-years) occurred in the study population. Treatment-resistant hypertension groups had a higher incidence rate of MACEs and renal events than the control groups. In multivariate Cox proportional hazards regression analysis, resistant hypertension by both definitions was significantly associated with increased risk of MACE and renal event. Both the previous and updated definitions of resistant hypertension were significant predictors of MACEs and renal events. This finding supports the adoption of the updated criteria for resistant hypertension in clinical practice.
Chun et al. (Sun,) conducted a cohort in High-risk hypertension (n=2,018). Resistant hypertension (2018 AHA definition ≥130/80 mm Hg vs 2008 definition ≥140/90 mm Hg) vs. Non-resistant hypertension was evaluated on Major adverse cardiovascular events (MACEs) and renal events. Resistant hypertension, defined by either the 2008 (≥140/90 mm Hg) or 2018 (≥130/80 mm Hg) AHA criteria, was significantly associated with increased risk of MACEs and renal events.