In patients with apparent treatment resistant hypertension, age > 60 years was independently associated with increased all-cause mortality (OR 1.57; 95% CI 1.36-1.72).
Cohort (n=632)
No
Apparent treatment resistant hypertension carries a high risk of cardiovascular events and mortality across all age groups, including young patients under 40.
Odds Ratio: 1.57 (95% CI 1.36–1.72)
Objective: Complications of arterial hypertension are more frequent in patients (pts) with resistant hypertension (RH), often defined as blood pressure (BP) > = 140x90 mmHg on >3 antihypertensive drugs. There are barriers for the diagnosis of true RH, and population-based studies frequently use the term apparent treatment RH (aTRH) to emphasize that pseudoresistance was not excluded. It is not well established if there are age differences in the main end-organ damage (EOD) and outcomes of aTRH. We aim to evaluate EOD, cardiovascular and renal events, and all-cause mortality in pts with aTRH according to age. Design and method: Retrospective analysis of 632 pts with aTRH, mean follow-up 6.43±2 years (yrs) in a tertiary hospital. Patients were divided into three groups according to age range: young (= 60 yrs, n=188). Age differences were analyzed regarding EOD: left ventricular hypertrophy (LVH) and ventricular systolic and diastolic dysfunction were analyzed by echocardiogram; estimated glomerular filtration rate (eGFR), major adverse cardiovascular events (MACE), renal events, stroke, and all-cause mortality. MACE were defined as the composite of myocardial infarction, myocardial revascularization, or heart failure. Results: Our cohort consisted of 632 pts, 357 (56.5%) women, mean age 52.6±11 yrs, mean BMI 30±5.8 kg/m2, BP at admission 171±29/101±29 mmHg, 3.5±1 antihypertensive drugs. The main results are detailed in Table 1. At follow-up, 175 (27.6%) pts died. In logistic regression analysis the independent factors for all-cause mortality were diabetes (1.41, 95%CI 1.12-1.61), chronic kidney disease (CKD) (1.67, 95%CI 1.52-1.8), LVH (1.41, 95% 1.12-1.61), and age > 60 years (1.57, 95%CI 1.36-1.72).Conclusions: In a middle-aged population with aTRH: 1) Cardiac and renal damage were less severe in young than adults and elderly 2) The incidence of MACE (38,8%) and stroke (12.6%) were elevated in the young similar to adults and elderly. 3) Among pts <40 yrs, 13.6% died at follow-up 4) All-cause mortality was associated with diabetes, CKD, LVH, and old age. Apparent resistant hypertension carries an ominous prognosis and should be faced as a health public problem.
bortolotto et al. (2026) conducted a cohort in Apparent treatment resistant hypertension (aTRH) (n=632). Age > 60 years vs. Age ≤ 60 years was evaluated on All-cause mortality (OR 1.57, 95% CI 1.36-1.72). In patients with apparent treatment resistant hypertension, age > 60 years was independently associated with increased all-cause mortality (OR 1.57; 95% CI 1.36-1.72).