Key result
Resistant hypertension linked to ~340% higher rate of major cardiovascular events versus controlled hypertension.
Why the study?
The study was conducted to determine markers of disease progression and the risk of cardiovascular complications in patients with resistant arterial hypertension.
Does resistant arterial hypertension and elevated baseline biomarkers increase the risk of cardiovascular and renal complications compared to controlled hypertension?
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.
Supports heightened risk awareness in resistant hypertension; leaves open whether intensified therapy improves outcomes.
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<0.001) and an average daily SBP > 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.
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Bezrodna et al. (2026) 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).
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