TY - JOUR
T1 - Prevalence, predictors, and outcomes in treatment-resistant hypertension in patients with coronary disease
AU - Bangalore, Sripal
AU - Fayyad, Rana
AU - Laskey, Rachel
AU - Demicco, David A.
AU - Deedwania, Prakash
AU - Kostis, John B.
AU - Messerli, Franz H.
N1 - Funding Information:
Funding: The study was funded by Pfizer, Inc .
Funding Information:
Conflict of Interest: SB is an ad hoc consultant for Daiichi Sankyo and Boehringer Ingelheim. RF, RL, and DD are employees of Pfizer, Inc. PD is a consultant speaker for Pfizer, Inc. JBK has research grants from Novartis (significant) , AngelMed (significant) , and Medtronic (modest) ; is on the Speakers' Bureau of Merck (modest) and Sanofi-Aventis (modest); and is a consultant to Merck (significant). FHM performs ad hoc consulting for Abbott, Novartis, Pfizer, Inc, Bayer, Forest, Takeda, and Daiichi, and performs research and receives grants from Novartis and Boehringer .
PY - 2014/1
Y1 - 2014/1
N2 - Background: Increasingly, apparent treatment-resistant hypertension has been recognized. However, much of the prevalence, predictors, and outcomes are largely unknown, especially in patients with coronary artery disease. Methods: We evaluated 10,001 patients with coronary artery disease who were enrolled in the Treating to New Targets trial. Apparent treatment-resistant hypertension was defined as blood pressure ≥140 mm Hg despite 3 antihypertensive agents or <140 mm Hg with ≥4 antihypertensive agents. The primary outcome was major cardiovascular events (composite of fatal coronary heart disease, nonfatal myocardial infarction, resuscitated cardiac arrest, and stroke). Results: Among the 10,001 patients in the trial, 1112 (11.1%) had apparent treatment-resistant hypertension. In a multivariable model adjusting for baseline differences, the treatment-resistant hypertension group had a 64% increase in primary outcome (hazard ratio [HR], 1.64; 95% confidence interval [CI], 1.39-1.94; P <.001), driven by a 69% increase in coronary heart disease death (HR, 1.69; 95% CI, 1.22, 2.34; P =.001) and 73% increase in nonfatal myocardial infarction (HR, 1.73; 95% CI, 1.39-2.16, P <.0001) when compared with the no apparent treatment-resistant hypertension group. In addition, patients with apparent treatment-resistant hypertension had a 71% increase in major coronary event (P <.0001), 45% increase in death (P =.001), 33% increase in heart failure (P =.05), 53% increase in any cardiovascular event (P <.0001), 60% increase in any coronary event (P <.0001), 68% increase in angina (P <.0001), and 51% increase in coronary revascularization (P <.0001) when compared with the no apparent treatment-resistant hypertension group. Results were largely similar whether the definition of apparent treatment-resistant hypertension was based on a blood pressure ≥140 mm Hg despite 3 agents or a blood pressure <140 mm Hg with ≥4 agents. Conclusions: In patients with coronary artery disease, apparent treatment-resistant hypertension is associated with a marked increase in the risk of cardiovascular morbidity and mortality, including an increase in all-cause death.
AB - Background: Increasingly, apparent treatment-resistant hypertension has been recognized. However, much of the prevalence, predictors, and outcomes are largely unknown, especially in patients with coronary artery disease. Methods: We evaluated 10,001 patients with coronary artery disease who were enrolled in the Treating to New Targets trial. Apparent treatment-resistant hypertension was defined as blood pressure ≥140 mm Hg despite 3 antihypertensive agents or <140 mm Hg with ≥4 antihypertensive agents. The primary outcome was major cardiovascular events (composite of fatal coronary heart disease, nonfatal myocardial infarction, resuscitated cardiac arrest, and stroke). Results: Among the 10,001 patients in the trial, 1112 (11.1%) had apparent treatment-resistant hypertension. In a multivariable model adjusting for baseline differences, the treatment-resistant hypertension group had a 64% increase in primary outcome (hazard ratio [HR], 1.64; 95% confidence interval [CI], 1.39-1.94; P <.001), driven by a 69% increase in coronary heart disease death (HR, 1.69; 95% CI, 1.22, 2.34; P =.001) and 73% increase in nonfatal myocardial infarction (HR, 1.73; 95% CI, 1.39-2.16, P <.0001) when compared with the no apparent treatment-resistant hypertension group. In addition, patients with apparent treatment-resistant hypertension had a 71% increase in major coronary event (P <.0001), 45% increase in death (P =.001), 33% increase in heart failure (P =.05), 53% increase in any cardiovascular event (P <.0001), 60% increase in any coronary event (P <.0001), 68% increase in angina (P <.0001), and 51% increase in coronary revascularization (P <.0001) when compared with the no apparent treatment-resistant hypertension group. Results were largely similar whether the definition of apparent treatment-resistant hypertension was based on a blood pressure ≥140 mm Hg despite 3 agents or a blood pressure <140 mm Hg with ≥4 agents. Conclusions: In patients with coronary artery disease, apparent treatment-resistant hypertension is associated with a marked increase in the risk of cardiovascular morbidity and mortality, including an increase in all-cause death.
KW - Outcome
KW - Predictors
KW - Prevalence
KW - Resistant hypertension
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U2 - 10.1016/j.amjmed.2013.07.038
DO - 10.1016/j.amjmed.2013.07.038
M3 - Article
C2 - 24210549
AN - SCOPUS:84891633653
SN - 0002-9343
VL - 127
SP - 71-81.e1
JO - American Journal of Medicine
JF - American Journal of Medicine
IS - 1
ER -