Incidence and Prognosis of Resistant Hypertension in Hypertensive Patients

TLDR

Resistant hypertension’s incidence and prognosis remain largely unknown despite recent AHA consensus highlighting its importance. The authors conducted a retrospective cohort study of 205,750 incident hypertension patients treated between 2002 and 2006 across two integrated health plans, following them for development of resistant hypertension—defined as uncontrolled blood pressure despite ≥3 antihypertensive drugs—using prescription fill and blood pressure data, and assessing subsequent cardiovascular events while adjusting for patient and clinical characteristics. They found that 1.9% (≈1 in 50) of patients developed resistant hypertension within a median of 1.5 years, and these patients had a 47% higher adjusted risk of cardiovascular events over a median 3.8‑year follow‑up, underscoring the need for intensified hypertension management.

Abstract

Background— Despite a recent American Heart Association (AHA) consensus statement emphasizing the importance of resistant hypertension, the incidence and prognosis of this condition are largely unknown. Methods and Results— This retrospective cohort study in 2 integrated health plans included patients with incident hypertension in whom treatment was begun between 2002 and 2006. Patients were followed up for the development of resistant hypertension based on AHA criteria of uncontrolled blood pressure despite use of ≥3 antihypertensive medications, with data collected on prescription filling information and blood pressure measurement. We determined incident cardiovascular events (death or incident myocardial infarction, heart failure, stroke, or chronic kidney disease) in patients with and without resistant hypertension with adjustment for patient and clinical characteristics. Among 205 750 patients with incident hypertension, 1.9% developed resistant hypertension within a median of 1.5 years from initial treatment (0.7 cases per 100 person-years of follow-up). These patients were more often men, were older, and had higher rates of diabetes mellitus than nonresistant patients. Over 3.8 years of median follow-up, cardiovascular event rates were significantly higher in those with resistant hypertension (unadjusted 18.0% versus 13.5%, P <0.001). After adjustment for patient and clinical characteristics, resistant hypertension was associated with a higher risk of cardiovascular events (hazard ratio, 1.47; 95% confidence interval, 1.33–1.62). Conclusions— Among patients with incident hypertension in whom treatment was begun, 1 in 50 patients developed resistant hypertension. Patients with resistant hypertension had an increased risk of cardiovascular events, which supports the need for greater efforts toward improving hypertension outcomes in this population.