Resistant hypertension was associated with a higher risk of death, nonfatal MI, or nonfatal stroke compared with controlled hypertension in patients with CAD (HR 1.27; 95% CI 1.13-1.43).
Observational (n=17,190)
Yes
Does resistant hypertension increase the risk of adverse cardiovascular outcomes in patients with coronary artery disease and hypertension?
Resistant hypertension is common (38%) in patients with coronary artery disease and hypertension, and is associated with a significantly higher risk of adverse cardiovascular outcomes compared to controlled hypertension.
Hazard Ratio: 1.27 (95% CI 1.13–1.43)
OBJECTIVE: Resistant hypertension (res-HTN) is a challenging problem, but little is known of res-HTN in patients with coronary artery disease (CAD). In this post-hoc INternational VErapamil SR-Trandolapril STudy (INVEST) analysis, we assessed prevalence, predictors, and impact on outcomes of res-HTN in CAD patients with hypertension. METHODS: Participants (n=17190) were divided into three groups according to achieved blood pressure (BP): controlled (BP <140/90 mmHg on three or fewer drugs) ; uncontrolled (BP ≥ 40/90 mmHg on two or fewer drugs) ; or resistant (BP ≥ 40/90 mmHg on three drugs or any patient on at least four drugs). RESULTS: The prevalence of res-HTN was 38%: significant predictors of res-HTN included heart failure odds ratio (OR) 1. 73, diabetes (OR 1. 63), Black race (OR 1. 50), and US residence (OR 1. 50). Compared with controlled HTN, res-HTN had multivariate-adjusted association with higher risk of adverse outcomes first occurrence of all-cause death, nonfatal myocardial infarction, or nonfatal stroke hazard ratio 1. 27, 95% confidence interval (CI) 1. 13-1. 43, and individual outcomes of all-cause death (hazard ratio 1. 29, 95% CI 1. 13-1. 48), cardiovascular mortality (hazard ratio 1. 47, 95% CI 1. 21-1. 78), and nonfatal stroke (hazard ratio 1. 61, 95% CI 1. 17-2. 22), but not nonfatal myocardial infarction (hazard ratio 0. 98, 95% CI 0. 72-1. 34). Adverse outcomes, except nonfatal stroke, did not differ in patients with res-HTN compared to uncontrolled HTN. CONCLUSIONS: Res-HTN is common in patients with CAD and hypertension, associated with poor prognosis, and linked with a number of conditions. Emphasis should be placed on recognizing those at risk for res-HTN and future studies should examine whether more aggressive treatment of res-HTN improves outcomes.
Smith et al. (2013) conducted an observational in Coronary artery disease and hypertension (n=17,190). Resistant hypertension vs. Controlled hypertension was evaluated on First occurrence of all-cause death, nonfatal myocardial infarction, or nonfatal stroke (HR 1.27, 95% CI 1.13-1.43). Resistant hypertension was associated with a higher risk of death, nonfatal MI, or nonfatal stroke compared with controlled hypertension in patients with CAD (HR 1.27; 95% CI 1.13-1.43).