Key result
Resistant hypertension linked to ~17% higher MACE risk vs non-resistant hypertension, driven by ischemic stroke.
Why the study?
Does resistant hypertension increase the risk of MACE and stroke in Taiwanese patients with hypertension?
Cohort (n=111,986)
Does resistant hypertension increase the risk of MACE and stroke in Taiwanese patients with hypertension?
Hazard Ratio: 1.17 (95% CI 1.09–1.26)
Absolute Event Rate: 13.9% vs 10%
p-value: p=<0.001
Resistant hypertension is associated with a significantly increased risk of MACE and ischemic stroke, particularly in female and elderly patients.
Should not yet change practice; extends the MACE association to Taiwanese patients and leaves open causal confirmation.
BACKGROUND: Little is known about the prognosis of resistant hypertension (RH) in Asian population. This study aimed to evaluate the impacts of RH in Taiwanese patients with hypertension, and to ascertain whether patient characteristics influence the association of RH with adverse outcomes. METHODS AND RESULTS: Patients aged ≥45 years with hypertension were identified from the National Health Insurance Research Database. Medical records of 111,986 patients were reviewed in this study, and 16,402 (14.6%) patients were recognized as having RH (continuously concomitant use of ≥3 anti-hypertensive medications, including a diuretic, for ≥2 years). Risk of major adverse cardiovascular events (MACE, a composite of all-cause mortality, acute coronary syndrome, and stroke [included both fatal and nonfatal events]) in patients with RH and non-RH was analyzed. A total of 11,856 patients experienced MACE in the follow-up period (average 7.1±3.0 years). There was a higher proportion of females in the RH group, they were older than the non-RH (63.1 vs. 60.5 years) patients, and had a higher prevalence of cardiovascular co-morbidities. Overall, patients with RH had higher risks of MACE (adjusted HR 1.17; 95%CI 1.09-1.26; p<0.001). Significantly elevated risks of stroke (10,211 events; adjusted HR 1.17; 95%CI 1.08-1.27; p<0.001), especially ischemic stroke (6,235 events; adjusted HR 1.34; 95%CI 1.20-1.48; p<0.001), but not all-cause mortality (4,594 events; adjusted HR 1.06; 95%CI 0.95-1.19; p = 0.312) or acute coronary syndrome (2,145 events; adjusted HR 1.17; 95%CI 0.99-1.39; p = 0.070) were noted in patients with RH compared to those with non-RH. Subgroup analysis showed that RH increased the risks of stroke in female and elderly patients. However, no significant influence was noted in young or male patients. CONCLUSIONS: Patients with RH were associated with higher risks of MACE and stroke, especially ischemic stroke. The risks were greater in female and elderly patients than in male or young patients.
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Hung et al. (2014) conducted a cohort in Hypertension (n=111,986). Resistant hypertension vs. Non-resistant hypertension was evaluated on Major adverse cardiovascular events (MACE, a composite of all-cause mortality, acute coronary syndrome, and stroke) (HR 1.17, 95% CI 1.09-1.26, p=<0.001). Resistant hypertension was associated with a 17% higher risk of major adverse cardiovascular events (adjusted HR 1.17) compared to non-resistant hypertension, driven primarily by ischemic stroke.
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