Comparative risk of renal, cardiovascular, and mortality outcomes in controlled, uncontrolled resistant, and nonresistant hypertension

We sought to compare the risk of end-stage renal disease (ESRD), ischemic heart event (IHE), congestive heart failure (CHF), cerebrovascular accident (CVA), and all-cause mortality among 470,386 individuals with resistant and nonresistant hypertension (non-RH). Resistant hypertension (60,327 individ...

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Bibliographic Details
Published in:Kidney international Vol. 88; no. 3; pp. 622 - 632
Main Authors: Sim, John J., Bhandari, Simran K., Shi, Jiaxiao, Reynolds, Kristi, Calhoun, David A., Kalantar-Zadeh, Kamyar, Jacobsen, Steven J.
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01.09.2015
Elsevier Limited
Subjects:
Aged
Antihypertensive Agents - therapeutic use
Blood Pressure - drug effects
Cardiovascular Diseases - diagnosis
Cardiovascular Diseases - etiology
Cardiovascular Diseases - mortality
cardiovascular outcomes
Cerebrovascular Disorders - etiology
Chi-Square Distribution
Disease-Free Survival
Drug Resistance
Female
Heart Failure - etiology
Humans
Hypertension - complications
Hypertension - diagnosis
Hypertension - drug therapy
Hypertension - mortality
Hypertension - physiopathology
Kaplan-Meier Estimate
Kidney Failure, Chronic - diagnosis
Kidney Failure, Chronic - etiology
Kidney Failure, Chronic - mortality
Male
Middle Aged
mortality outcomes
Multivariate Analysis
Myocardial Ischemia - etiology
Proportional Hazards Models
renal outcomes
resistant hypertension
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
cardiovascular outcomes
renal outcomes
resistant hypertension
mortality outcomes
ISSN:0085-2538, 1523-1755, 1523-1755
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Summary:We sought to compare the risk of end-stage renal disease (ESRD), ischemic heart event (IHE), congestive heart failure (CHF), cerebrovascular accident (CVA), and all-cause mortality among 470,386 individuals with resistant and nonresistant hypertension (non-RH). Resistant hypertension (60,327 individuals) was subcategorized into two groups: 23,104 patients with cRH (controlled on four or more medicines) and 37,223 patients with uRH (uncontrolled on three or more medicines) in a 5-year retrospective cohort study. Cox proportional hazard modeling was used to estimate hazard ratios adjusting for age, gender, race, body mass index, chronic kidney disease (CKD), and comorbidities. Resistant hypertension (cRH and uRH), compared with non-RH, had multivariable adjusted hazard ratios (95% confidence intervals) of 1.32 (1.27–1.37), 1.24 (1.20–1.28), 1.46 (1.40–1.52), 1.14 (1.10–1.19), and 1.06 (1.03–1.08) for ESRD, IHE, CHF, CVA, and mortality, respectively. Comparison of uRH with cRH had hazard ratios of 1.25 (1.18–1.33), 1.04 (0.99–1.10), 0.94 (0.89–1.01), 1.23 (1.14–1.31), and 1.01 (0.97–1.05) for ESRD, IHE, CHF, CVA, and mortality, respectively. Men and Hispanics had a greater risk for ESRD within all three cohorts. Individuals with resistant hypertension had a greater risk for ESRD, IHE, CHF, CVA, and mortality. The risk of ESRD and CVA were 25% and 23% greater, respectively, in uRH compared with cRH, supporting the linkage between blood pressure and both outcomes.
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ISSN:0085-2538
1523-1755
1523-1755
DOI:10.1038/ki.2015.142