RESISTANT HYPERTENSION AS A RISK FACTOR FOR CARDIOVASCULAR EVENTS IN PATIENTS WITH HYPERTENSIVE CRISES AFTER 12-MONTH FOLLOW-UP: A GREEK REGISTRY

Abstract

Objective: Currently, evidence on the prognosis of patients with hypertensive crises (HC) and resistant hypertension (RH) is limited. The purpose of our study was to register the prevalence, and clinical phenotype of patients with HC admitted to the emergency department (ED) and a 12-month follow-up to record cardiovascular outcomes in a Greek tertiary hospital. Design and method: The study population included patients visiting the ED with acute an increase in blood pressure (BP) (systolic BP > or = 180mmHg and/or diastolic BP > or = 120mmHg). HC patients were classified as hypertensive emergencies or urgencies depending on the presence or absence of acute hypertension-mediated organ damage, respectively. In all patients, the baseline characteristics were registered for 12 consecutive months. After stratification of the HC population by RH (excluding non-adherence to medication as a cause for HC), we created two subgroups, those with and without RH. Finally, we compared outcomes (composite endpoint of deaths or hospitalizations from cardiovascular causes) by RH during a 12-month follow-up. Results: Out of 38,589 patients assessed in the ED, 353(0.91%) had HC, of whom 256 had hypertensive urgencies, and 97 had emergencies. The clinical status of 81 patients was not available during follow-up. The mean age of the remaining HC patients was 68±13 years, 49.6% were males, and 80.3% had a history of hypertension (58 patients had RH). More patients with RH had composite events (27.6% vs. 12.8%, p<0.001), deaths (10.3% vs. 0.6%, p = 0.002), and hospitalizations (27.6% vs. 12.1%, p<0.001) from a cardiovascular cause. RH vs. non-RH phenotype was associated with OR 1.437 (95% CI 1.006-2.012) after adjustment for confounders. Conclusions: RH is an independent risk factor of increased cardiovascular risk in patients with HC.