Cardiovascular Prognosis in Drug-Resistant Hypertension Stratified by 24-Hour Ambulatory Blood Pressure: The JAMP Study
Authors: Kario Kazuomi , Hoshide Satoshi , Narita Keisuke , Okawara Yukie , Kanegae Hiroshi , Aoki Kenji , Kihara Hajime , Koga Toshiro , Nakata Tomoaki , Oku Kenji , Matsuoka Yasufumi , Omori Hiroaki , Nishizawa Masafumi , Tanno Yasuo , Fukase Yoko , Omi Koki , Takahashi Jun , Mizuno Hiroyuki , Saito Michiya , Yatabe Junichi , Eguchi Kazuo , Iwashita Kiyoshi , Kumada Maki , Oki Gaku , Oki Gaku , Kabutoya Tomoyuki , Eguchi Kazuo , Hojo Yukihiro , Ichida Masaru , Ishikawa Shizukiyo , Komori Takahiro , Matsui Yoshio , Matsumoto Masatoshi , Nagasaka Shoichiro , Nakano Masahiro , Nishimura Yoshioki , Okada Kenta , Shimada Kazuyuki , Shimpo Masahisa , Takahashi Nozomu , Uno Hideyuki , Ishikawa Joji , Ishikawa Shizukiyo , Eguchi Kazuo , Kabutoya Tomoyuki , Komori Takahiro , Kuroda Toshio , Hirahara Nobutsune , Kemi Yuta , Yoshioka Hisashi , Hoshi Sakuo , Mizuno Atsuhi , Ohno Kunihiko , Okazaki Osamu , Saito Tsunehiro , Tanaka Tetsu , Yamashiro Kazuo , Yamauchi Tatsuyuki , Yo Shisei , Yomogita Shigeru , Hikita Sayaka , Hoshi Sakuo , Kawase Yasuhiro , Nojiri Yoshifumi , Sato Yukihiro , Uchiba Kiyoshi , Ishiguro Motoyuki , Taguchi Atsushi , Iida Kazumasa , Takemoto Tatsuya , Tone Katsuyuki , Abe Hideyasu , Abe Yasuhisa , Hasegawa Masami , Katsuya Tomohiro , Okada Yoshiharu , Tanaka Shinichiro , Tanke Genyo , Takami Takeshi , Michiura Jun , Shiotani Masahiko , Aoki Tomohiro , Ogura Koichi , Kawamura Yuzuru , Nakanishi Shigekiyo , Sasaki Nobuo , Takahashi Toshiyuki , Fujii Akihisa , Tanaka Eiichiro , Katayama Hiroyuki , Matsui Yoshio , Matsui Yoshio , Fukutomi Motoki , Miyoshi Kosuke , Naito Hiroaki , Yokota Sawa , Nakamura Kazumasa , Yokota Tetsu , Takasugi Shinsuke , Fujita Shuichiro , Fujita Yumiko , Kaneko Hitoshi , Fujiwara Takeshi , Kitamura Wataru , Anan Yuhei , Deguchi Tomohiro , Imaizumi Yuki , Miyagi Jun , Imaizumi Yuki , Tsuji Takahiro , Uchiwa Yasuhiro , Ueda Shin , Yamaguchi Takeya , Imaizumi Yuki , Yoshida Tetsuro , Yoshinaga Ryo , Maeda Kosuke , Kunitomo Kotaro , Soda Kyousei , Baba Hirotoshi , Yonezu Keisuke , Hino Akihiro , Miura Genta , Nakamura Tomoko , Kuroki Munetoshi , Omori Fumihiko , Hidaka Toshiaki , Hidaka Takanori , Yano Yuichiro , Kanemaru Yoshimasa , Kitani Michitaka , Koga Masahiro , Kubo Hirohide , Kuwabara Masachika , Miyata Junichi , Nagata Masahiko , Sasaki Koji , Tamaki Noboru , Tasaka Hiroyasu , Yokota Naoto , Yano Yuichiro , Miyata Takahiro , Katsuren Eiyu , Kudeken Norifumi , Yagi Noriharu 
Published: November 2021

Resistant hypertension is an important cardiovascular risk factor. This analysis of the JAMP study (Japan Ambulatory Blood Pressure Monitoring Prospective) data investigated the effects of uncontrolled resistant hypertension diagnosed using ambulatory blood pressure (BP) monitoring on the risk of heart failure (HF) and overall cardiovascular events. The JAMP study patients with hypertension and no HF history were included. They had true resistant hypertension (24-hour BP ≥130/80 mm Hg), pseudoresistant hypertension (24-hour BP <130/80 mm Hg), well-controlled nonresistant hypertension (24-hour BP <130/80 mm Hg), or uncontrolled nonresistant hypertension (24-hour BP ≥130/80 mm Hg). The primary end point was total cardiovascular events, including atherosclerotic cardiovascular disease (fatal/nonfatal stroke and fatal/nonfatal coronary artery disease), and HF. During 4.5±2.4 years of follow-up the overall incidence per 1000 person-years was 10.1 for total cardiovascular disease, 4.1 for stroke, 3.5 for coronary artery disease, and 2.6 for HF. The adjusted risk of total cardiovascular and HF events was significantly increased in patients with true resistant versus controlled nonresistant hypertension (hazard ratio, 1.66 [95% CI, 1.12–2.48];
P
=0.012 and 2.24 [95% CI, 1.17–4.30];
P
=0.015, respectively) and versus uncontrolled nonresistant hypertension (1.51 [1.03–2.20];
P
=0.034 and 3.03 [1.58–5.83];
P
<0.001, respectively). The findings were robust in a sensitivity analysis using a slightly different definition of resistant hypertension. True resistant hypertension diagnosed using ambulatory BP monitoring is a significant independent risk factor for cardiovascular disease events, especially for HF. This highlights the importance of diagnosing and effectively treating resistant hypertension.

Registration:

URL:
https://www.umin.ac.jp/ctr
; Unique identifier: UMIN000020377.