Cardiovascular outcome in treated hypertensive patients with true and false responder hypertension

The aim of this study was to evaluate cardiovascular outcome in treated hypertensive patients with true responder hypertension, i.e, normal clinic and ambulatory blood pressure, and false responder hypertension, i.e, normal clinic but high ambulatory blood pressure. The occurrence of fatal and nonfatal cardiovascular events was evaluated in 340 patients (129 M and 211 W, age 59±10 yrs) with true responder hypertension (clinic BP < 140/90 mmHg and daytime BP < 135/85 mmHg) and 126 patients (70 M and 56 W, age 59±12 yrs) with false responder hypertension (clinic blood pressure < 140/90 mmHg and daytime blood pressure > 135/85 mmHg). During follow-up period (5.2±3 yrs, range 0.5–11.6 yrs) 16 patients with true responder hypertension and 15 with false responder hypertension developed a cardiovascular event. The event-rate per 100 patient-yrs was 0.87 in subjects with true responder hypertension and 2.42 in those with false responder hypertension. The probability of event-free survival was significantly different among the groups (Log-rank test, P=0.004). After adjustment for several covariates, including clinic blood pressure, Cox regression analysis showed that false responder hypertension was an independent predictor of cardiovascular events (false responder hypertension vs true responder hypertension, RR 2.19, 95% CI 1.04–4.6, P < 0.05). Other independent predictors of outcome were age, smoking habit, low-density lipoprotein cholesterol, and left ventricular hypertrophy (all P < 0.05). The present study shows that treated hypertensive patients with false responder hypertension are at higher risk than those with true responder hypertension. Ambulatory blood pressure monitoring should be also considered in treated hypertensive patients with apparently responder hypertension.