Abstract
BackgroundResistant hypertension is associated with adverse clinical outcome in hypertensive patients. However, the prognostic significance of resistant hypertension in patients with heart failure remains uncertain.Methods and ResultsThe 1 year survival and heart failure re-hospitalization rate of 1288 consecutive patients admitted to a university hospital for either newly diagnosed heart failure or an exacerbation of prior chronic heart failure was analyzed. Resistant hypertension was defined as uncontrolled blood pressure (>140/90 mmHg) despite being compliant with an antihypertensive regimen that includes 3 or more drugs (including a diuretic). A total of 176 (13.7%) heart failure patients had resistant hypertension. There was no difference in all cause mortality, cardiovascular mortality, and heart failure related re-hospitalization between patients with versus without resistant hypertension. Diabetes [hazard ratio = 1.62, 95% confidence interval = 1.13–2.34; P = 0.010] and serum sodium >139 mmol/L (hazard ratio = 1.54, 95% confidence interval = 1.06–2.23; P = 0.024) were independently associated with resistant hypertension. Patients with resistant hypertension had a relatively higher survival rate (86.9% vs. 83.8%), although the difference was not significant (log-rank x2 = 1.00, P = 0.317). In patients with reduced ejection fraction, heart failure related re-hospitalization was significantly lower in patients with resistant hypertension (45.8% vs. 59.1%, P = 0.050).ConclusionsResistant hypertension appears to be not associated with adverse clinical outcome in patients with heart failure, in fact may be a protective factor for reduced heart failure related re-hospitalization in patients with reduced ejection fraction.
Highlights
Hypertension is a major public health problem with a global prevalence ranging from about 20% to 40% [1,2]
Among all the patients included, mean age was 75.2¡11.9 years, ranged from 31–102 years; 713 (55.4%) patients were female; 519 (40.3%) were HFREF patients; 381 (29.6%) patients received more than 3 antihypertensive medications; 679 (52.7%) patients reached optimal blood pressure (BP) target; a total of 176 (13.7%) heart failure patients were found to combine with resistant hypertension
Patients with resistant hypertension had a higher incidence of diabetes, a remarkably higher level of serum sodium and albumin, and were more commonly prescribed with statins
Summary
Hypertension is a major public health problem with a global prevalence ranging from about 20% to 40% [1,2]. Resistant hypertension was associated with a significantly increased risk of adverse cardiovascular events compared with non-resistant hypertension and represents an important public health issue. Heart failure is another ubiquitous cause of mortality and morbidity. There was no difference in all cause mortality, cardiovascular mortality, and heart failure related re-hospitalization between patients with versus without resistant hypertension. In patients with reduced ejection fraction, heart failure related re-hospitalization was significantly lower in patients with resistant hypertension (45.8% vs 59.1%, P50.050). Conclusions: Resistant hypertension appears to be not associated with adverse clinical outcome in patients with heart failure, may be a protective factor for reduced heart failure related re-hospitalization in patients with reduced ejection fraction
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