@article{5ea8b1e0973449a583c5877b72bdcc65,
title = "Resistant hypertension: A frequent and ominous finding among hypertensive patients with atherothrombosis",
abstract = "AimsThe 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 resultsResistant 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).ConclusionThe presence of resistant hypertension identifies a subgroup of patients with hypertension and atherothrombosis who are at heightened risk for adverse long-term outcomes.",
keywords = "Atherosclerosis, Heart failure, Mortality, Resistant hypertension, Stroke",
author = "Kumbhani, {Dharam J.} and Steg, {P. Gabriel} and Cannon, {Christopher P.} and Eagle, {Kim A.} and Smith, {Sidney C.} and Kevin Crowley and Shinya Goto and Ohman, {E. Magnus} and Bakris, {George L.} and Perlstein, {Todd S.} and Scott Kinlay and Bhatt, {Deepak L.}",
note = "Funding Information: Conflict of interest: D.J.K.: Honoraria: American College of Cardiology, SomahLutions. Ph.G.S.: Research grant from Servier; participated in consultancy or advisory board for Eisai, Amgen, Astellas, Bayer, Boehringer Ingelheim, BMS, Daiichi-Sankyo-Lilly, GSK, Merck, Pfizer, Roche, The Medicines Company, AstraZeneca, Sanofi-Aventis, Servier; and being a stockholder in Aterovax. C.P.C.: Research grants from Intekrin Therapeutics, Accumetrics, AstraZeneca, GlaxoSmithK-line, Merck, Takeda; honoraria from Pfizer, AstraZeneca; participated in consultancy or advisory board for Bristol-Myers Squibb/Sanofi, Novartis, Alnylam; and having ownership interest in Automedics Medical Systems. K.A.E.: Grant/research support from Bristol-Myers Squibb, Blue Cross Blue Shield of Michigan, the National Institutes of Health (NIH), Sanofi-Aventis, the Mardigian Foundation Varbedian Fund, GORE, and the Hewlett Foundation and being a consultant for the NIH National Heart, Lung, and Blood Institute, Sanofi-Aventis, and the Robert Wood Johnson. Foundation: S.C.S.: None. K.C.: None. S.G.: Research grants from Sanofi-Aventis, Eisai, Berlinger-Ingelheim; participated in consultancy or advisory board for Eisai, Sanofi-Aventis, Otsuka. E.M.O.: Research grants from Bristol-Myers Squibb, CV Therapeutics, Daiichi-Sankyo, Datascope, Eli Lilly, Marquet, Sanofi-Aventis, Schering-Plough, and The Medicines Company, and providing consulting or other services for Abiomed, AstraZeneca, CV Therapeutics, Datascope, Gilead Sciences, Liposcience, Marquet, Northpoint Domain, Pozen, Response Biomedical, Sanofi-Aventis, The Medicines Company, and WebMD (theheart.org). G.L.B.: Research Grants from Forest Labs, Relapsya, WebMD and Consultant to: Abbott, Takeda, Johnson & Johnson, Daichi-Sankyo, Medtronic. T.S.P.: None. S.K.: None. D.L.B.: Advisory Board: Medscape Cardiology; Board of Directors: Boston VA Research Institute, Society of Chest Pain Centers; Chair: American Heart Association Get With The Guidelines Science Subcommittee; Honoraria: American College of Cardiology (Editor, Clinical Trials, Cardiosource), Duke Clinical Research Institute (clinical trial steering committees), Slack Publications (Chief Medical Editor, Cardiology Today Intervention), WebMD (CME steering committees); Other: Senior Associate Editor, Journal of Invasive Cardiology; Research Grants: Amarin, Astra-Zeneca, Bristol-Myers Squibb, Eisai, Ethicon, Medtronic (co-PI of SYM-PLICITY HTN-3), Sanofi-Aventis, The Medicines Company; Unfunded Research: FlowCo, PLx Pharma, Takeda. Funding Information: The REACH Registry is sponsored by Sanofi-Aventis, Bristol-Myers Squibb, and the Waksman Foundation (Tokyo, Japan). The REACH Registry is endorsed by the World Heart Federation. No funding was received for this manuscript. No sponsors reviewed this manuscript.",
year = "2013",
month = apr,
day = "21",
doi = "10.1093/eurheartj/ehs368",
language = "English (US)",
volume = "34",
pages = "1204--1214",
journal = "European heart journal",
issn = "0195-668X",
publisher = "Oxford University Press",
number = "16",
}