PROGNOSTIC OF PATIENTS WITH REFRACTORY HYPERTENSION IN A COHORT OF RESISTANT HYPERTENSIVES

Abstract

Objective: To determine prognostic value of true refractory hypertension diagnosis in a large cohort of resistant hypertensives Design and method: Prospective cohort study enrolled 835 patients of a large historical cohort of RHTN. After at least 6 months of follow-up, 147 (17.6%) patients remained refractory to treatment in ABPM despite the use of 5 or more drugs, including a thiazide-like diuretic and spironolactone. All of them were submitted to a standard protocol including laboratory tests, ABPM, echocardiography, and pulse wave velocity (PWV). Primary outcomes were total mortality, cardiovascular mortality, and fatal and non-fatal cardiovascular events. Secondary outcomes were major cardiovascular events separately (coronary artery disease, cerebrovascular disease, chronic kidney disease with substitutive therapy, peripheral arterial disease). Person-time rates for interest outcomes were calculated to find correlations of Kaplan-Meier survival curves using Cox regression multivariate models, after adjustments for several risk factors. Follow-up remained until December 2021 Results: The median follow-up was 162 months [IQR 115–196]. When compared to resistant hypertensives, patients with RfHTN were younger and more obese. Regarding subclinical lesions, refractories presented less aortic stiffness (13 vs 21%, p = 0.02) and stage 3 chronic kidney diseases (26 vs 34%, p = 0.03) with albuminuria and LVMI similar to those of resistant hypertension despite uncontrolled ambulatory blood pressure. There were 232 all causes deaths (21.1 vs 29.2%), of which 122 from CV causes (12.9% vs 15%), and 253 total CV events (44.1% vs 49%). The diagnosis of RfHTN was associated with a significantly lower risk of all-cause mortality when adjusted by sex and age. It also presented a tendency to be a protective factor of cardiovascular death, chronic kidney disease with substitutive therapy and peripheral arterial disease, although without statistical significance. Risk ratio ranged from 0.62 to 0,94 for every analysis/adjustment, except incidence of stroke (IC95%:1.22(0.70–2.17) after every adjustment in RfHTN. Conclusions: Despite uncontrolled ABPM, refractory hypertensive patients presented lower overall and cardiovascular morbimortality at long-term when compared to non-refractory ones, except stroke, which seems to be at least partially influenced by spironolactone use.