Predictors and outcomes of resistant hypertension among patients with coronary artery disease and hypertension

Steven M. Smith, Yan Gong, Eileen Handberg, Franz H. Messerli, George L. Bakris, Ali Ahmed, Anthony A. Bavry, Carl J. Pepine, Rhonda M. Cooper-Dehoff

Research output: Contribution to journalArticlepeer-review

79 Scopus citations


Obective: Resistant hypertension (res-HTN) is a challenging problem, but little is known of res-HTN in patients with coronary artery disease (CAD). In this post-hoc INternational VErapamil SR-Trandolapril STudy (INVEST) analysis, we assessed prevalence, predictors, and impact on outcomes of res-HTN in CAD patients with hypertension. Methods: Participants (n=17190) were divided into three groups according to achieved blood pressure (BP): controlled (BP <140/90mmHg on three or fewer drugs); uncontrolled (BP ≥140/90mmHg on two or fewer drugs); or resistant (BP ≥140/90mmHg on three drugs or any patient on at least four drugs). Results: The prevalence of res-HTN was 38%: significant predictors of res-HTN included heart failure [odds ratio (OR) 1.73], diabetes (OR 1.63), Black race (OR 1.50), and US residence (OR 1.50). Compared with controlled HTN, res-HTN had multivariate-adjusted association with higher risk of adverse outcomes {first occurrence of all-cause death, nonfatal myocardial infarction, or nonfatal stroke [hazard ratio 1.27, 95% confidence interval (CI) 1.13-1.43], and individual outcomes of all-cause death (hazard ratio 1.29, 95% CI 1.13-1.48), cardiovascular mortality (hazard ratio 1.47, 95% CI 1.21-1.78), and nonfatal stroke (hazard ratio 1.61, 95% CI 1.17-2.22), but not nonfatal myocardial infarction (hazard ratio 0.98, 95% CI 0.72-1.34)}. Adverse outcomes, except nonfatal stroke, did not differ in patients with res-HTN compared to uncontrolled HTN. ConclusionS: Res-HTN is common in patients with CAD and hypertension, associated with poor prognosis, and linked with a number of conditions. Emphasis should be placed on recognizing those at risk for res-HTN and future studies should examine whether more aggressive treatment of res-HTN improves outcomes.

Original languageEnglish (US)
Pages (from-to)635-643
Number of pages9
JournalJournal of hypertension
Issue number3
StatePublished - Mar 2014
Externally publishedYes


  • Blood pressure
  • Coronary artery disease
  • Hypertension
  • Resistant hypertension

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine


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