Prevalence, predictors, and outcomes of both true- and pseudo-resistant hypertension in the action to control cardiovascular risk in diabetes trial: a cohort study
Prevalence, predictors, and outcomes of both true- and pseudo-resistant hypertension in the action to control cardiovascular risk in diabetes trial: a cohort study
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DOI：
10.1038/s41440-021-00739-6
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发表时间：
2021-09-13
影响因子：
5.4
通讯作者：
Choudhry, Niteesh
中科院分区：
文献类型：
--
作者：
Chiu, Nicholas;Lauffenburger, Julie;Choudhry, Niteesh
难治性高血压（RH）的研究很少，因为很难将其与不依从性区分开来，而排除不依从性是准确诊断RH的必要条件。因此，人们对真正RH的患病率、预测因素和结果知之甚少。我们评估了1838名来自控制糖尿病心血管风险行动试验标准血压组的患者。我们将患者分为三组：“真RH”、“伪RH”（即血压水平可归类为RH但非粘附性RH的患者）和“其他”（即不能归类为“真RH”或“伪RH”的患者）。我们检查了真RH和伪RH的预测因子，以及真RH与非致死性心肌梗死、非致死性卒中或心血管死亡的复合结局之间的关系。在1838名信息完整的参与者中，489名（26.6%）符合真实RH的定义，94名（16.1%）RH患者在前12个月的>= 1次就诊时出现“伪RH”。RH的预测因素包括：基线收缩压bb0 = 160 mmHg （OR = 8.79, 95% CI: 5.70-13.68）和基线收缩压在140-159之间（OR = 2.91, 95% CI: 2.13-4.00），与收缩压< 140相比，额外的基线血压药物（OR = 3.40, 95% CI: 2.83-4.11），大量白蛋白尿（OR = 2.35, 95% CI: 1.50-3.67）， CKD (OR = 1.53, 95% CI: 0.99-2.33)，卒中史（OR = 1.73, 95% CI: 1.04-2.82）和黑人（OR = 1.39, 95% CI: 1.02-1.88）；交叉验证的c统计量为0.80。“真RH”患者的综合预后风险增加65% （HR = 1.65; 95% CI: 1.13-2.42）。总之，大多数被归类为RH的患者都是“真正的RH”，这在黑人、大量蛋白尿、慢性肾病、中风、基线收缩压较高以及服用更多基线抗高血压药物的患者中更为常见。这些患者发生心血管疾病和死亡事件的风险增加。
Resistant hypertension (RH) has been poorly studied due to the difficulty in distinguishing it from nonadherence-the exclusion of which is necessary to accurately diagnose RH. Therefore, little is known about the prevalence, predictors, and outcomes of true RH. We evaluated 1838 patients from the standard blood pressure (BP) arm of the Action to Control Cardiovascular Risk in Diabetes Trial. We classified patients into three groups: "true RH", "pseudo-RH" (i.e., patients with BP levels that would classify them as RH but who were non-adherent), and "other" (i.e., those who could not be classified as having "true RH" or "pseudo-RH"). We examined predictors of true and pseudo-RH and the relationship between true RH and the composite outcome of nonfatal MI, nonfatal stroke, or cardiovascular death. Among 1838 participants with complete information, 489 (26.6%) met the definition of true RH, and 94 (16.1%) RH patients had "pseudo-RH" on >= 1 visit over the first 12 months. Predictors of RH included: baseline SBP >= 160 mmHg (OR = 8.79; 95% CI: 5.70-13.68) and baseline SBP between 140-159 (OR = 2.91; 95% CI: 2.13-4.00) compared to SBP < 140, additional baseline BP medication (OR = 3.40; 95% CI: 2.83-4.11), macroalbuminuria (OR = 2.35; 95% CI: 1.50-3.67), CKD (OR = 1.53; 95% CI: 0.99-2.33), history of stroke (OR = 1.73; 95% CI: 1.04-2.82), and black race (OR = 1.39; 95% CI: 1.02-1.88); the cross-validated C-statistic was 0.80. "True RH" patients had a 65% increased hazard in composite outcome (HR = 1.65; 95% CI: 1.13-2.42). In conclusion, the majority of patients classified as having RH had "true RH," which was more common among those who are black, have macroalbuminuria, CKD, stroke, higher baseline SBP, and are taking more baseline antihypertensives. These patients are at increased risk for cardiovascular and mortality events.