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Dynamic resistant hypertension patterns as predictors of cardiovascular morbidity: a 4-year prospective study

Tsioufis, Costasa; Kasiakogias, Alexandrosa; Kordalis, Athanasiosa; Dimitriadis, Kyriakosa; Thomopoulos, Costasa; Tsiachris, Dimitriosa; Vasileiou, Panagiotisa; Doumas, Michalisd; Makris, Thomase; Papademetriou, Vasiliosb; Kallikazaros, Ioannisa; Bakris, Georgec; Stefanadis, Christodoulosa

doi: 10.1097/HJH.0000000000000023
ORIGINAL PAPERS: Resistant hypertension

Objective: Little is known regarding the clinical course and prognosis of resistant hypertension (RHT). We evaluated predictors of persistent RHT and the associated cardiovascular risk.

Methods: We studied 1911 treated hypertensive patients (aged 59±11 years, 49% men) for a mean period of 3.9 years. At baseline, clinical data were collected and patients underwent echocardiographic measurements, routine blood testing and additional workup for exclusion of secondary causes of RHT (office-based uncontrolled hypertension under at least three drugs including a diuretic or controlled hypertension under four or more drugs). Endpoint of interest was the composite of coronary artery disease and stroke.

Main results: Four groups were identified depending on presence or absence of RHT at baseline and follow-up: 1153 patients (60%) never having RHT, 189 (10%) with resolved RHT, 204 (11%) with incident RHT and 365 (19%) with persistent RHT. Two-thirds of the patients with RHT at baseline remained resistant at the end of the study. Independent variables associated with both incident and persistent RHT were diabetes mellitus, history of cardiovascular disease, hypertension duration, SBP, left ventricular hypertrophy and glomerular filtration rate. Persistent RHT compared with never-having RHT was associated with a 2.2-fold increased risk for cardiovascular morbidity (95% CI: 1.21–4.05, P = 0.01) after adjustment for risk factors.

Conclusion: In treated hypertensive patients, among prospective RHT dynamic patterns, persistent RHT is frequent and independently associated with adverse cardiovascular prognosis.

aFirst Cardiology Clinic, University of Athens Medical School, Hippokration Hospital, Athens, Greece

bVeterans Affairs Medical Center, Cardiology Department and Georgetown Medical Centers, Washington, District of Columbia

cDepartment of Medicine, Hypertensive Diseases Unit, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA

d2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki.

eDepartment of Cardiology, Elena Venizelou Hospital, Athens, Greece.

Correspondence to Costas Tsioufis, MD, 3 Kolokotroni Street, 15236 P.Penteli, Athens, Greece. Tel: +302106131393; fax: +302132089522; e-mail:

Abbreviations: CAD, coronary artery disease; eGFR, estimated glomerular filtration rate; LVH, left ventricular hypertrophy; LVMI, left ventricular mass index; OSA, obstructive sleep apnea; RHT, resistant hypertension

Received 27 March, 2013

Revised 26 July, 2013

Accepted 12 September, 2013

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins