Abstract P326: Apparent Treatment Resistant Hypertension and Risk for Stroke, Coronary Heart Disease and All-cause Mortality
Authors: Irvin Marguerite R , Booth III John N , Shimbo Daichi , Lackland Daniel T , Oparil Suzanne , Howard George , Safford Monika , Muntner Paul , Calhoun David A 
Published: July 2021

Apparent treatment resistant hypertension (aTRH) is characterized as uncontrolled hypertension (HTN) with the use of 3 or more antihypertensive medication classes or controlled HTN while treated with 4 or more antihypertensive medication classes. Few data are available on the association of aTRH with cardiovascular disease outcomes in comparison to more easily controlled HTN. We evaluated the risk for stroke, coronary heart disease (CHD) and all-cause mortality among 2,043 participants with aTRH and 9,519 participants with controlled HTN (systolic blood pressure < 140 mm Hg and diastolic blood pressure < 90 mm Hg) treated with < 4 antihypertensive medication classes from the population-based REasons for Geographic And Racial Differences in Stroke (REGARDS) study. aTRH was further categorized as controlled aTRH (≥ 4 antihypertensive medication classes and controlled HTN) and uncontrolled aTRH (≥ 3 antihypertensive medication classes and uncontrolled HTN). Participants with and without aTRH, respectively, were 68±9 and 66±9 years of age, 60.5% (1236 0f 2043) and 46.8% (4455 of 9519) black, and 49.2% (1005 of 2043) and 40.8% (3884 of 9519) male. After adjusting for demographic, clinical and comorbid factors, the hazard ratio (HR) for stroke, CHD, and all-cause mortality associated with aTRH (vs. controlled HTN and < 4 medication classes) was 1.29 (95% CI 0.96-1.73), 1.90 (95% CI 1.40-2.58), and 1.36 (95% CI 1.20-1.55), respectively. Compared to those with controlled hypertension, the multivariable-adjusted HR for stroke, CHD and all-cause mortality was increased for those with uncontrolled aTRH but not those with controlled aTRH (Table 1). Compared to those with controlled aTRH, uncontrolled aTRH was associated with CHD (HR 2.33; 95% CI: 1.21 [[Unable to Display Character: &#8211;]] 4.48) but not stroke (HR 1.05; 95% CI: 0.61 [[Unable to Display Character: &#8211;]] 1.81) or all-cause mortality (HR 1.15; 95% CI: 0.91 [[Unable to Display Character: &#8211;]] 1.45). We conclude achieving blood pressure control within aTRH is paramount to decrease risk for events similarly to other patients with more easily controlled HTN.

Table 1.
Hazard ratios for stroke, coronary heart disease, and all-cause mortality associated with apparent treatment resistant hypertension (aTRH). *< 4 antihypertensive medication classes Models are adjusted for age, race, gender, and geographic region of residence, waist circumference, smoking status, physical activity, alcohol consumption, C - reactive protein, statin use, Morisky score for medication adherence, total cholesterol, HDL-cholesterol, and hypertension duration, estimated glomerular filtration rate < 60 ml/min/1.73m
2
, albuminuria, and diabetes. Hazard ratios for stroke were also adjusted for history of coronary heart disease. Hazard ratios for coronary heart disease were also adjusted for history of stroke. Hazard ratios for all-cause mortality were also adjusted for history of coronary heart disease and stroke.