Abstract 13186: Prevalence, Predictors, and Outcomes of Both True- and Pseudo-resistant Hypertension in the Action to Control Cardiovascular Risk in Diabetes Trial (ACCORD)

Abstract

Introduction: Resistant hypertension (RH) has been poorly studied due to the difficulty distinguishing RH from medication non-adherence—exclusion of which is necessary to accurately diagnose RH. Therefore, little is known about prevalence, predictors, and outcomes of true RH, particularly for patients with diabetes. Objective: To characterize prevalence, predictors, and outcomes of true RH under a definition accounting for adherence in a study with strict adherence monitoring. Methods: We analyzed data from 1838 patients in the standard BP arm of ACCORD. Patients were classified into 3 mutually-exclusive groups: “true RH”, “pseudo-RH” (i.e., patients with BP treatment levels that would classify them as having RH, but who were non-adherent), and “Other” (i.e., those without “true RH” or “pseudo-RH” classifications). Predictors of true- and pseudo-RH were identified with logistic and boosted regression models. Relationship between true RH and primary composite outcome of nonfatal MI, nonfatal stroke, or cardiovascular death was evaluated with cox models. Results: Among 1838 participants with complete information, 489 (26.6%) met the definition of true RH, and 94 (16.1%) of RH patients had “pseudo-RH” on ≥1 visit over the first 12 months. Multivariable predictors of RH included: baseline SBP ≥160 mmHg (OR=8.79; 95CI:5.70-13.68), baseline SBP between 140-159 (OR=2.91; 95CI:2.13-4.00) compared to SBP <140, additional baseline BP medication (OR=3.40; 95CI:2.83-4.11), macroalbuminuria (OR=2.35; 95CI:1.50-3.67), CKD (OR=1.53; 95CI:0.99-2.33), history of stroke (OR=1.73; 95CI:1.04-2.82), and black race (OR=1.39; 95CI:1.02-1.88); Overall, multivariable model had a cross-validated C-statistic of 0.80, indicating strong discriminative ability. “True RH” patients had a 65% increased hazard in primary outcome compared with other groups (HR=1.65; 95 CI:1.13-2.42). Conclusions: The majority of patients classified as RH had “true RH,” with only 16% being “pseudo-RH” due to non-adherence. True RH is more common among those who are black, have macroalbuminuria, CKD, history of stroke, higher baseline SBP, and are taking more baseline anti-hypertensives. “True RH” patients are at increased risk for cardiovascular and mortality events.