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Resistant hypertension is associated with an increased cardiovascular risk compared to patients controlled on a similar multi-drug regimen

Journal of Human Hypertension volume 37, pages 542–547 (2023) Cite this article

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Abstract

The long-term risk associated with resistant hypertension compared to other phenotypes of hypertension is still unclear. We aimed to assess cardiovascular and renal outcomes over 10 years of follow-up of patients with uncontrolled resistant hypertension (uRH) compared to a similarly treated (≥ 3 medication classes including a diuretic) and adherent group whose blood pressure is under control. This retrospective cohort study utilized the computerized database of Maccabi Healthcare Services, a state-mandated health provider covering 25% of the Israeli population. Clinical outcomes were assessed using Cox regression multivariable analyses. A total of 1487 patients (50% males, mean age at baseline = 68.3 ± 10.4 years) were included in the uRH cohort and 1343 patients (50% males, 66.2 ± 10.6 years) in the controlled hypertension reference group (Controlled hypertension on multi drug regimen- CH-MDR). After adjusting for age, sex, BMI and patients’ comorbidities, uRH was associated with a Hazard Ratio of 1.35 (95% CI: 1.08–1.69) for incidence of ischemic heart disease, 1.51 (1.06–2.16) for secondary cardiovascular events, and 1.36 (1.00–1.86) for risk of stroke or transient ischemic attack compared to the reference group. Patients with uRH were found to have more hospitalization days (mean, 4.2 vs. 3 days per year, p < 0.001), and more emergency room visits (83.3% vs. 77%, p < 0.001). Overall, uRH was associated with a 19% (95% CI 11% to 29%) increase in direct healthcare expenditures during the first year of follow-up. uRH is associated with a substantial increased risk of both cardiovascular and cerebrovascular events, when compared to similarly treated hypertensive patients whose blood pressure is under control.

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Fig. 1: Unadjusted Kaplan Meier curve for time till IHD event by groups (All).
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Fig. 2: Unadjusted Kaplan Meier curve for time till CVA/TIA event by groups (All).
The alternative text for this image may have been generated using AI.
Fig. 3
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Fig. 4
The alternative text for this image may have been generated using AI.

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Data availability

The datasets analyzed during the current study are not publicly available due to patient confidentiality but are available from the correspo12nding author on reasonable request.

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Funding

Funded by an educational grant from Medtronic.

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Authors and Affiliations

  1. Institute of Nephrology and Hypertension, Assuta Ashdod University Hospital, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel

    Adi Leiba & Avital Angel-Korman

  2. Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel

    Adi Leiba, Avital Angel-Korman & Baruch Weinreb

  3. Maccabitech Institute for Research & Innovation, Maccabi Healthcare Services, Tel Aviv, Israel

    Naama Yekutiel, Gabriel Chodick & Joshua Wortsman

  4. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Gabriel Chodick

Authors
  1. Adi Leiba
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  2. Naama Yekutiel
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  4. Joshua Wortsman
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  5. Avital Angel-Korman
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Contributions

NY, GC, JW, and BW designed the protocol and participated in designing the study concept; NY conducted the search for qualifying patients, extracted and analyzed the data. AL and AAK interpreted the results. AL, NY, GC, and AAK wrote the first draft of the report. All authors provided feedback on the report, agree with its contents and approved the final version.

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Correspondence to Adi Leiba.

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Competing interests

Dr. Weinreb is a consultant for Medtronic.

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Approved by MHS Institutional Review Board (IRB).

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Leiba, A., Yekutiel, N., Chodick, G. et al. Resistant hypertension is associated with an increased cardiovascular risk compared to patients controlled on a similar multi-drug regimen. J Hum Hypertens 37, 542–547 (2023). https://doi.org/10.1038/s41371-022-00749-y

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