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Resistant hypertension: a frequent and ominous finding among hypertensive patients with atherothrombosis.

Publication ,  Journal Article
Kumbhani, DJ; Steg, PG; Cannon, CP; Eagle, KA; Smith, SC; Crowley, K; Goto, S; Ohman, EM; Bakris, GL; Perlstein, TS; Kinlay, S; Bhatt, DL ...
Published in: Eur Heart J
April 2013

AIMS: The effect of resistant hypertension on outcomes in patients with atherothrombotic disease is currently unknown. Accordingly, we sought to determine the prevalence and outcomes of resistant hypertension in stable hypertensive outpatients with subclinical or established atherothombotic disease enrolled in the international Reduction of Atherothrombosis for Continued Health (REACH) registry. METHODS AND RESULTS: Resistant hypertension was defined as a blood pressure ≥140/90 mmHg at baseline (≥130/80 mmHg if diabetes/renal insufficiency) with the use of ≥3 antihypertensive medications, including a diuretic. The primary outcome was a composite of cardiovascular death, myocardial infarction, or stroke at 4 years. A total of 53 530 hypertensive patients were included. The prevalence of resistant hypertension was 12.7%; 6.2% on 3 antihypertensive agents, 4.6% on 4 agents, and 1.9% on ≥5 agents (mean: 4.7 ± 0.8). In addition to a diuretic, these patients were being treated mostly with ACE-inhibitors/angiotensin receptor blockers (90.1%), beta-blockers (67.0%), and calcium channel blockers (50.8%). Patients with resistant hypertension had a higher risk of the primary endpoint on multivariable analysis [hazard ratio (HR) 1.11, 95% confidence interval (CI) 1.02-1.20; P = 0.017], including an increased non-fatal stroke risk (HR: 1.26; 95% CI: 1.10-1.45; P = 0.0008). Hospitalizations due to congestive heart failure were higher (P < 0.0001). Patients on ≥5 agents had a higher adjusted risk for the primary endpoint when compared with those on ≤3 agents (P = 0.03). CONCLUSION: The presence of resistant hypertension identifies a subgroup of patients with hypertension and atherothrombosis who are at heightened risk for adverse long-term outcomes.

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Published In

Eur Heart J

DOI

EISSN

1522-9645

Publication Date

April 2013

Volume

34

Issue

16

Start / End Page

1204 / 1214

Location

England

Related Subject Headings

  • Treatment Outcome
  • Thrombosis
  • Stroke
  • Myocardial Infarction
  • Male
  • Hypertension
  • Humans
  • Hospitalization
  • Follow-Up Studies
  • Female
 

Citation

APA
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Kumbhani, D. J., Steg, P. G., Cannon, C. P., Eagle, K. A., Smith, S. C., Crowley, K., … REACH Registry Investigators, . (2013). Resistant hypertension: a frequent and ominous finding among hypertensive patients with atherothrombosis. Eur Heart J, 34(16), 1204–1214. https://doi.org/10.1093/eurheartj/ehs368
Kumbhani, Dharam J., P Gabriel Steg, Christopher P. Cannon, Kim A. Eagle, Sidney C. Smith, Kevin Crowley, Shinya Goto, et al. “Resistant hypertension: a frequent and ominous finding among hypertensive patients with atherothrombosis.Eur Heart J 34, no. 16 (April 2013): 1204–14. https://doi.org/10.1093/eurheartj/ehs368.
Kumbhani DJ, Steg PG, Cannon CP, Eagle KA, Smith SC, Crowley K, et al. Resistant hypertension: a frequent and ominous finding among hypertensive patients with atherothrombosis. Eur Heart J. 2013 Apr;34(16):1204–14.
Kumbhani, Dharam J., et al. “Resistant hypertension: a frequent and ominous finding among hypertensive patients with atherothrombosis.Eur Heart J, vol. 34, no. 16, Apr. 2013, pp. 1204–14. Pubmed, doi:10.1093/eurheartj/ehs368.
Kumbhani DJ, Steg PG, Cannon CP, Eagle KA, Smith SC, Crowley K, Goto S, Ohman EM, Bakris GL, Perlstein TS, Kinlay S, Bhatt DL, REACH Registry Investigators. Resistant hypertension: a frequent and ominous finding among hypertensive patients with atherothrombosis. Eur Heart J. 2013 Apr;34(16):1204–1214.
Journal cover image

Published In

Eur Heart J

DOI

EISSN

1522-9645

Publication Date

April 2013

Volume

34

Issue

16

Start / End Page

1204 / 1214

Location

England

Related Subject Headings

  • Treatment Outcome
  • Thrombosis
  • Stroke
  • Myocardial Infarction
  • Male
  • Hypertension
  • Humans
  • Hospitalization
  • Follow-Up Studies
  • Female