Key result
Resistant hypertension was significantly associated with an increased risk of the composite outcome of in-hospital mortality and morbidity (HR 1.857) in hospitalized patients with cardiorenal multimorbidity.
Why the study?
Resistant hypertension can occur in conditions such as heart failure and reduced renal function and may confer high cardiovascular risk, but its prevalence and link to clinical outcomes in hospitalized cardiorenal multimorbid patients needed evaluation.
Does resistant hypertension increase the risk of adverse in-hospital outcomes in patients with cardiorenal multimorbidity?
Cross-Sectional (n=141)
No
Does resistant hypertension increase the risk of adverse in-hospital outcomes in patients with cardiorenal multimorbidity?
Hazard Ratio: 1.857 (95% CI 1.17–2.946)
p-value: p=0.009
Resistant hypertension is highly prevalent in hospitalized patients with cardiorenal multimorbidity and is associated with an increased risk of a composite of in-hospital morbidity and mortality.
Supports risk stratification in cardiorenal multimorbidity; hypothesis-generating for prospective trials before practice change.
INTRODUCTION: Resistant hypertension (RH) is characterized by the failure to reach a goal blood pressure despite the administration of three medications at maximally tolerated doses, one of which being a diuretic. RH can be observed in a variety of clinical conditions, such as heart failure and reduced renal function and may confer high cardiovascular risk. AIM: To evaluate the prevalence of RH and its association with clinical outcomes; the primary outcome was in-hospital mortality and the composite outcome was all-cause of mortality and morbidity in a cohort of patients with cardiorenal multimorbidity hospitalized in an internal medicine ward. METHODS: We conducted a retrospective analysis of consecutive hypertensive patients with cardiorenal multimorbidity. The composite outcome incorporated all-cause of in-hospital mortality and occurrence of sepsis, pulmonary embolism, acute coronary syndrome, stroke and renal replacement therapy. RESULTS: We collected data in 141 inpatients with a mean age of 77 years ± 10 (males 65.9 %), estimated glomerular filtration rate of 34 ± 18.6 ml/min with length of stay of 17 ± 12 days. The prevalence of RH was 52.4%. In-hospital mortality was observed in 24 patients (17%) and the composite outcome occurred in 87 patients (61.7%) and among these 74 (85.1%) were patients with RH. Free survival for composite outcome was significantly higher in patients without RH than patients with RH (log rank 7.52, p = 0.006). Resistant hypertension was a risk factor for composite outcome [HR 1.857(C.I. 1.170-2.946, p = 0.009)]. CONCLUSION: In patients with cardiorenal multimorbidity there is a high proportion of RH that represents a risk factor for composite outcome but not for in-hospital mortality.
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Gigante et al. (2023) conducted a cross-sectional in Cardiorenal multimorbidity and hypertension (n=141). Resistant hypertension vs. Patients without resistant hypertension was evaluated on Composite outcome of all-cause in-hospital mortality and occurrence of sepsis, pulmonary embolism, acute coronary syndrome, stroke, and renal replacement therapy (HR 1.857, 95% CI 1.170-2.946, p=0.009). Resistant hypertension was significantly associated with an increased risk of the composite outcome of in-hospital mortality and morbidity (HR 1.857) in hospitalized patients with cardiorenal multimorbidity.
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