MO084: Resistant Hypertension is Associated With an Increased Cardiovascular Risk Compared to Patients Controlled on a Similar Multi-Drug Regimen

Abstract

Abstract BACKGROUND AND AIMS The long-term risk associated with resistant hypertension as compared with other phenotypes of hypertension is still unclear. This has been a result of heterogeneity in the definition of both resistant and non-resistant hypertension. We aimed at assessing the cardiovascular and renal outcomes of resistant hypertension compared with a similarly treated (≥3 medication classes including a diuretic) patients whose blood pressure is under control. METHOD This retrospective cohort study utilized the computerized database of Maccabi Healthcare Services (MHS). Over a 10 years follow up, a historical cohort of patients with baseline uncontrolled resistant hypertension were compared to a similar cohort of hypertensive examinees, whose BP was well controlled. Clinical outcomes were assessed using Cox regression multivariable analyses. RESULTS —A total of 1487 patients (50% males, mean age at baseline = 68.3 ± 10.4 years) were included in the resistant hypertension cohort and 1343 patients (50% males, 66.2 ± 10.6y) in the controlled hypertension reference group. After adjusting for age, sex, BMI and patients’ comorbidities, uncontrolled resistant hypertension was associated with a hazard ratio (HR) of 1.35 (95% CI: 1.08–1.69) for incidence of ischemic heart disease and 1.51 (1.06–2.16) for secondary cardiovascular events compared to the reference group. It also was associated with an increased risk of stroke or TIA (HR = 1.36; 95% CI: 1.00–1.86). Patients with resistant hypertension had more hospitalization days (mean = 4.2 days versus 3 days per year, P < 0.001), and more emergency room visits during follow-up period (83.3% versus 77%, P < 0.001). Overall, uncontrolled resistant hypertension was associated with a 19% (95% CI: 11–29%) increase in the direct healthcare expenditure during the first year of follow-up. CONCLUSION Resistant hypertension is associated with a 35% increased risk of both cardiovascular and cerebrovascular events, when compared with a similarly treated hypertensive patients whose blood pressure is under control. Physicians should overcome therapeutic inertia and add a fourth or a fifth anti-hypertensive medication, even when treating patients who are already on a multi-drug regimen.