Uncontrolled hypertension was associated with higher rates of heart failure (HR 1.15; 95% CI 1.01-1.31), MI (HR 2.72), stroke (HR 1.16), ESKD (HR 39.35), and CV mortality (HR 1.29).
Cohort (n=11,538)
Does uncontrolled hypertension increase the risk of cardiorenal and metabolic outcomes in patients treated with >=2 antihypertensive drugs?
Uncontrolled hypertension in patients on multiple antihypertensive drugs is associated with significantly higher risks of adverse cardiorenal outcomes, particularly ESKD and MI.
Hazard Ratio: 1.15 (95% CI 1.01–1.31)
Objective: Despite the availability of multiple antihypertensive medications, many patients with hypertension (HTN) remain uncontrolled. Understanding the prognosis of patients with uncontrolled HTN is vital for informing optimal management strategies. We compared the rates of cardiorenal and metabolic outcomes between patients whose HTN was controlled versus uncontrolled. Design and method: Patients in Tianjin, China, with a diagnosis of HTN treated with >=2 antihypertensive drugs between 2018-2023 were identified using electronic health records. Patients were considered uncontrolled if their first blood pressure (BP) measurement while treated with >=2 antihypertensive drugs for at least 28 days (index date) was >=130/80 mmHg for patients aged =140/90 mmHg for patients aged >=80 years old. The incidence rates (per 100 person-years) of heart failure (HF), stroke, myocardial infarction (MI), type 2 diabetes (T2D), end stage kidney disease (ESKD), all-cause and cardiovascular (CV) disease mortality and major adverse cardiovascular events (MACE defined as stroke, MI, or all-cause mortality) during follow-up were calculated. Unadjusted and multivariable Cox proportional hazards models (adjusted for baseline patient characteristics) assessed differences in rates of the above outcomes between the two groups. Results: 11,538 patients on >=2 antihypertensive medications and with BP data were included, of which 6,932 (60.1%) had uncontrolled HTN. The mean (standard deviation) age at index of patients with uncontrolled and controlled HTN was 64.9 (10.3) years and 68.1 (11.1) years, respectively. Median (25th, 75th centile) follow-up time was approximately 2.3 (1.2, 3.6) years. Adjusted hazard ratios (HR) revealed an increased rate of HF (HR: 1.15 95% confidence interval (CI): 1.01, 1.31), MI (HR: 2.72 95% CI: 1.86, 3.98), stroke (HR: 1.16 95% CI: 1.01, 1.34), ESKD (HR: 39.35 95% CI: 14.35, 107.90) and cardiovascular mortality (HR: 1.29 95% CI: 1.05, 1.60) in those with uncontrolled vs controlled HTN. Conclusions: Patients with uncontrolled HTN had higher rates of adverse cardiorenal outcomes, such as MI, stroke, ESKD and CV-related mortality, despite multiple therapies. Early patient identification and implementation of effective management strategies for uncontrolled HTN are crucial to improving long-term cardiorenal outcomes in these patients.
Wang et al. (Fri,) conducted a cohort in Hypertension (n=11,538). Uncontrolled hypertension vs. Controlled hypertension was evaluated on Heart failure (HR 1.15, 95% CI 1.01-1.31). Uncontrolled hypertension was associated with higher rates of heart failure (HR 1.15; 95% CI 1.01-1.31), MI (HR 2.72), stroke (HR 1.16), ESKD (HR 39.35), and CV mortality (HR 1.29).