Resistance to antihypertensive treatment and long-term risk: The Atherosclerosis Risk in Communities study

Magnus O. Wijkman, Marcus V.B. Malachias, Brian L. Claggett, Susan Cheng, Kunihiro Matsushita, Amil M. Shah, Pardeep S. Jhund, Josef Coresh, Scott D. Solomon, Orly Vardeny

Research output: Contribution to journalArticlepeer-review

Abstract

More stringent blood pressure (BP) goals have led to greater prevalence of apparent resistant hypertension (ARH), yet the long-term prognostic impact of ARH diagnosed according to these goals in the general population remains unknown. We assessed the prognostic impact of ARH according to contemporary BP goals in 9612 participants of the Atherosclerosis Risk in Communities (ARIC) study without previous cardiovascular disease. ARH, defined as BP above goal (traditional goal <140/90 mmHg, more stringent goal <130/80 mmHg) despite the use of ≥3 antihypertensive drug classes or any BP with ≥4 antihypertensive drug classes (one of which was required to be a diuretic) was compared with controlled hypertension (BP at goal with 1-3 antihypertensive drug classes). Cox regression models were adjusted for age, sex, race, study center, BMI, heart rate, smoking, eGFR, LDL, HDL, triglycerides, and diabetes. Using the traditional BP goal, 133 participants (3.8% of the treated) had ARH. If the more stringent BP goal was instead applied, 785 participants (22.6% of the treated) were reclassified from controlled hypertension to uncontrolled hypertension (n = 725) or to ARH (n = 60). Over a median follow-up time of 19 years, ARH was associated with increased risk for a composite end point (all-cause mortality, hospitalization for myocardial infarction, stroke, or heart failure) regardless of whether traditional (adjusted HR 1.50, 95% CI: 1.23-1.82) or more stringent (adjusted HR 1.43, 95% CI: 1.20-1.70) blood pressure goals were applied. We conclude that in patients free from cardiovascular disease, ARH predicted long-term risk regardless of whether traditional or more stringent BP criteria were applied.

Original languageEnglish (US)
Pages (from-to)1887-1896
Number of pages10
JournalJournal of Clinical Hypertension
Volume23
Issue number10
DOIs
StatePublished - Oct 2021
Externally publishedYes

Bibliographical note

Funding Information:
MOW has served on advisory boards or lectured for MSD, Lilly, Novo Nordisk, and Sanofi and has organized a professional regional meeting sponsored by Lilly, Rubin Medical, Sanofi, Novartis, and Novo Nordisk. MVBM serves on the advisory board and/or receives speaker fees from Abbott, Bayer, Biolab Sanus, Libbs, and Novo Nordisk. BLC has received consulting fees for Amgen, Biogen, Corvia, Myokardia, and Novartis. AMS reports research support through Brigham and Women's Hospital from Novartis and Philips Ultrasound and consulting fees from Philips Ultrasound and Edwards Lifesciences. PSJ´s employer the University of Glasgow has been paid by AstraZeneca for his time working on the DAPA‐HF and DELIVER trials and by Novartis for his time working on the PARADIGM‐HF and PARAGON‐HF trials, and he reports advisory board or speaker´s fees from AstraZeneca, Novartis, Boehringer Ingelheim and grants from Boehringer Ingelheim. JC reports grants from NIH and NKF and is an advisor to Healthy.io. SDS has received research grants from Actelion, Alnylam, Amgen, AstraZeneca, Bellerophon, Bayer, BMS, Celladon, Cytokinetics, Eidos, Gilead, GSK, Ionis, Lilly, Lone Star Heart, Mesoblast, MyoKardia, NIH/NHLBI, Neurotronik, Novartis, NovoNordisk, Respicardia, Sanofi Pasteur, and Theracos and has consulted for Abbott, Action Akros, Alnylam, Amgen, Arena, AstraZeneca, Bayer, Boeringer‐Ingelheim, BMS, Cardior, Cardurion, Corvia, Cytokinetics, Daiichi‐Sankyo, Gilead, GSK, Ironwood, Lilly, Merck, Myokardia, Novartis, Roche, Takeda, Theracos, Quantum Genetics, Cardurion, AoBiome, Janssen, Cardiac Dimensions, Tenaya, Sanofi‐Pasteur, Dinaqor, Tremeau, CellProThera, Moderna, and American Regent. SC, KM, and OV report no conflicts of interest.

Funding Information:
The Atherosclerosis Risk in Communities study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under Contract nos. (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I). MOW is supported by grants from The Swedish Heart Association, The Swedish Society of Medicine and Region Östergötland, Sweden. AMS is supported by NIH/NHLBI grants R01HL135008, R01HL143224, R01HL150342, R01HL148218, and K24HL152008.

Funding Information:
The Atherosclerosis Risk in Communities study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under Contract nos. (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I). MOW is supported by grants from The Swedish Heart Association, The Swedish Society of Medicine and Region ?sterg?tland, Sweden. AMS is supported by NIH/NHLBI grants R01HL135008, R01HL143224, R01HL150342, R01HL148218, and K24HL152008. The authors thank the staff and participants of the ARIC study for their important contributions.

Publisher Copyright:
© 2021 The Authors. The Journal of Clinical Hypertension published by Wiley Periodicals LLC.

Keywords

  • antihypertensive therapy
  • epidemiology
  • resistant hypertension

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

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