Resistance to antihypertensive treatment and long-term risk: The Atherosclerosis Risk in Communities study

Wijkman, M. O., Malachias, M. V.B., Claggett, B. L., Cheng, S., Matsushita, K., Shah, A. M., Jhund, P. S. , Coresh, J., Solomon, S. D. and Vardeny, O. (2021) Resistance to antihypertensive treatment and long-term risk: The Atherosclerosis Risk in Communities study. Journal of Clinical Hypertension, 23(10), pp. 1887-1896. (doi: 10.1111/jch.14269) (PMID:34547175)

Abstract

More stringent blood pressure (BP) goals have led to greater prevalence of apparent resistant hypertension (ARH), yet the long-term prognostic impact of ARH diagnosed according to these goals in the general population remains unknown. We assessed the prognostic impact of ARH according to contemporary BP goals in 9612 participants of the Atherosclerosis Risk in Communities (ARIC) study without previous cardiovascular disease. ARH, defined as BP above goal (traditional goal <140/90 mmHg, more stringent goal <130/80 mmHg) despite the use of ≥3 antihypertensive drug classes or any BP with ≥4 antihypertensive drug classes (one of which was required to be a diuretic) was compared with controlled hypertension (BP at goal with 1-3 antihypertensive drug classes). Cox regression models were adjusted for age, sex, race, study center, BMI, heart rate, smoking, eGFR, LDL, HDL, triglycerides, and diabetes. Using the traditional BP goal, 133 participants (3.8% of the treated) had ARH. If the more stringent BP goal was instead applied, 785 participants (22.6% of the treated) were reclassified from controlled hypertension to uncontrolled hypertension (n = 725) or to ARH (n = 60). Over a median follow-up time of 19 years, ARH was associated with increased risk for a composite end point (all-cause mortality, hospitalization for myocardial infarction, stroke, or heart failure) regardless of whether traditional (adjusted HR 1.50, 95% CI: 1.23-1.82) or more stringent (adjusted HR 1.43, 95% CI: 1.20-1.70) blood pressure goals were applied. We conclude that in patients free from cardiovascular disease, ARH predicted long-term risk regardless of whether traditional or more stringent BP criteria were applied.

• Item Type: Articles
• Additional Information: Funding information: The Atherosclerosis Risk in Communities study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under Contract nos. (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I). MOW is supported by grants from The Swedish Heart Association, The Swedish Society of Medicine and Region Östergötland, Sweden. AMS is supported by NIH/NHLBI grants R01HL135008, R01HL143224, R01HL150342, R01HL148218, and K24HL152008.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Jhund, Professor Pardeep
• Authors: Wijkman, M. O., Malachias, M. V.B., Claggett, B. L., Cheng, S., Matsushita, K., Shah, A. M., Jhund, P. S., Coresh, J., Solomon, S. D., and Vardeny, O.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Journal of Clinical Hypertension
• Publisher: Wiley
• ISSN: 1524-6175
• ISSN (Online): 1751-7176
• Published Online: 21 September 2021
• Copyright Holders: Copyright © 2021 The Authors
• First Published: First published in Journal of Clinical Hypertension 23(10): 1887-1896
• Publisher Policy: Reproduced under a Creative Commons licence