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Cardiovascular morbidity of severe resistant hypertension among treated uncontrolled hypertensives: a 4-year follow-up study
Data regarding the prognosis of resistant hypertension (RHTN) with respect to its severity is limited. We investigated the cardiovascular risk of severe RHTN in a prospective observational study. A cohort of 1700 hypertensive patient with treated uncontrolled HTN was followed for a mean period of 3....
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Published in: | Journal of human hypertension 2018-07, Vol.32 (7), p.487-493 |
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creator | Kasiakogias, Alexandros Tsioufis, Costas Dimitriadis, Kyriakos Konstantinidis, Dimitrios Koumelli, Areti Leontsinis, Ioannis Andrikou, Eirini Vogiatzakis, Nikos Marinaki, Smaragdi Petras, Dimitrios Fragoulis, Christos Konstantinou, Konstantinos Papademetriou, Vasilios Tousoulis, Dimitrios |
description | Data regarding the prognosis of resistant hypertension (RHTN) with respect to its severity is limited. We investigated the cardiovascular risk of severe RHTN in a prospective observational study. A cohort of 1700 hypertensive patient with treated uncontrolled HTN was followed for a mean period of 3.6 ± 1.8 years. At baseline, standard clinical and laboratory workup was performed, including testing for secondary causes of RHT where applicable. Three groups were identified depending on presence of RHTN (office-based uncontrolled HTN under at least three drugs including a diuretic) and levels of office systolic blood pressure (BP): 1187 patients (70%) without RHTN, 313 (18%) with not-severe RHTN (systolic BP |
doi_str_mv | 10.1038/s41371-018-0065-y |
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p
= 0.007). Even after multivariate adjustment for established risk factors including BP levels and isolated systolic HTN, severe RHTN remained as an independent predictor of the cardiovascular outcome (OR: 2.30, CI: 1.00–5.29,
p
= 0.05). In conclusion, among treated yet uncontrolled hypertensive patients, severe RHTN exhibits a significantly higher cardiovascular risk indicating the need for prompt management.</description><identifier>ISSN: 0950-9240</identifier><identifier>EISSN: 1476-5527</identifier><identifier>DOI: 10.1038/s41371-018-0065-y</identifier><identifier>PMID: 29713047</identifier><language>eng</language><publisher>London: Nature Publishing Group UK</publisher><subject>692/699/75/243 ; 692/700/1750 ; Blood pressure ; Cardiovascular disease ; Cardiovascular diseases ; Care and treatment ; Coronary artery disease ; Development and progression ; Diagnosis ; Epidemiology ; Health Administration ; Health risk assessment ; Heart diseases ; Hypertension ; Medicine ; Medicine & Public Health ; Morbidity ; Prognosis ; Public Health ; Risk factors</subject><ispartof>Journal of human hypertension, 2018-07, Vol.32 (7), p.487-493</ispartof><rights>Macmillan Publishers Limited, part of Springer Nature 2018</rights><rights>COPYRIGHT 2018 Nature Publishing Group</rights><rights>Copyright Nature Publishing Group Jul 2018</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c470t-56a4806ffce2524148afc5d84c7db98635cbf6032511a10cb11ac7a3a44f29b23</citedby><cites>FETCH-LOGICAL-c470t-56a4806ffce2524148afc5d84c7db98635cbf6032511a10cb11ac7a3a44f29b23</cites><orcidid>0000-0002-7636-6725</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29713047$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kasiakogias, Alexandros</creatorcontrib><creatorcontrib>Tsioufis, Costas</creatorcontrib><creatorcontrib>Dimitriadis, Kyriakos</creatorcontrib><creatorcontrib>Konstantinidis, Dimitrios</creatorcontrib><creatorcontrib>Koumelli, Areti</creatorcontrib><creatorcontrib>Leontsinis, Ioannis</creatorcontrib><creatorcontrib>Andrikou, Eirini</creatorcontrib><creatorcontrib>Vogiatzakis, Nikos</creatorcontrib><creatorcontrib>Marinaki, Smaragdi</creatorcontrib><creatorcontrib>Petras, Dimitrios</creatorcontrib><creatorcontrib>Fragoulis, Christos</creatorcontrib><creatorcontrib>Konstantinou, Konstantinos</creatorcontrib><creatorcontrib>Papademetriou, Vasilios</creatorcontrib><creatorcontrib>Tousoulis, Dimitrios</creatorcontrib><title>Cardiovascular morbidity of severe resistant hypertension among treated uncontrolled hypertensives: a 4-year follow-up study</title><title>Journal of human hypertension</title><addtitle>J Hum Hypertens</addtitle><addtitle>J Hum Hypertens</addtitle><description>Data regarding the prognosis of resistant hypertension (RHTN) with respect to its severity is limited. We investigated the cardiovascular risk of severe RHTN in a prospective observational study. A cohort of 1700 hypertensive patient with treated uncontrolled HTN was followed for a mean period of 3.6 ± 1.8 years. At baseline, standard clinical and laboratory workup was performed, including testing for secondary causes of RHT where applicable. Three groups were identified depending on presence of RHTN (office-based uncontrolled HTN under at least three drugs including a diuretic) and levels of office systolic blood pressure (BP): 1187 patients (70%) without RHTN, 313 (18%) with not-severe RHTN (systolic BP < 160 mmHg) and 200 (12%) with severe RHTN (systolic BP ≥ 160 mmHg). Endpoint of interest was cardiovascular morbidity set as the composite of coronary heart disease and stroke. During follow-up, incidence rates of cardiovascular events per 1000 person-years were 7.1 cases in the non-RHTN group, 12.4 cases in the not-severe RHTN group and 18 cases in the severe RHTN group. Unadjusted analysis showed that compared to uncontrolled patients without RHTN, patients with not-severe RHTN exhibited a similar risk but patients with severe RHTN had a significantly higher risk, by 2.5 times (CI: 1.28–4.73,
p
= 0.007). Even after multivariate adjustment for established risk factors including BP levels and isolated systolic HTN, severe RHTN remained as an independent predictor of the cardiovascular outcome (OR: 2.30, CI: 1.00–5.29,
p
= 0.05). In conclusion, among treated yet uncontrolled hypertensive patients, severe RHTN exhibits a significantly higher cardiovascular risk indicating the need for prompt management.</description><subject>692/699/75/243</subject><subject>692/700/1750</subject><subject>Blood pressure</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular diseases</subject><subject>Care and treatment</subject><subject>Coronary artery disease</subject><subject>Development and progression</subject><subject>Diagnosis</subject><subject>Epidemiology</subject><subject>Health Administration</subject><subject>Health risk assessment</subject><subject>Heart diseases</subject><subject>Hypertension</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Morbidity</subject><subject>Prognosis</subject><subject>Public Health</subject><subject>Risk 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Hypertens</addtitle><date>2018-07-01</date><risdate>2018</risdate><volume>32</volume><issue>7</issue><spage>487</spage><epage>493</epage><pages>487-493</pages><issn>0950-9240</issn><eissn>1476-5527</eissn><abstract>Data regarding the prognosis of resistant hypertension (RHTN) with respect to its severity is limited. We investigated the cardiovascular risk of severe RHTN in a prospective observational study. A cohort of 1700 hypertensive patient with treated uncontrolled HTN was followed for a mean period of 3.6 ± 1.8 years. At baseline, standard clinical and laboratory workup was performed, including testing for secondary causes of RHT where applicable. Three groups were identified depending on presence of RHTN (office-based uncontrolled HTN under at least three drugs including a diuretic) and levels of office systolic blood pressure (BP): 1187 patients (70%) without RHTN, 313 (18%) with not-severe RHTN (systolic BP < 160 mmHg) and 200 (12%) with severe RHTN (systolic BP ≥ 160 mmHg). Endpoint of interest was cardiovascular morbidity set as the composite of coronary heart disease and stroke. During follow-up, incidence rates of cardiovascular events per 1000 person-years were 7.1 cases in the non-RHTN group, 12.4 cases in the not-severe RHTN group and 18 cases in the severe RHTN group. Unadjusted analysis showed that compared to uncontrolled patients without RHTN, patients with not-severe RHTN exhibited a similar risk but patients with severe RHTN had a significantly higher risk, by 2.5 times (CI: 1.28–4.73,
p
= 0.007). Even after multivariate adjustment for established risk factors including BP levels and isolated systolic HTN, severe RHTN remained as an independent predictor of the cardiovascular outcome (OR: 2.30, CI: 1.00–5.29,
p
= 0.05). In conclusion, among treated yet uncontrolled hypertensive patients, severe RHTN exhibits a significantly higher cardiovascular risk indicating the need for prompt management.</abstract><cop>London</cop><pub>Nature Publishing Group UK</pub><pmid>29713047</pmid><doi>10.1038/s41371-018-0065-y</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-7636-6725</orcidid></addata></record> |
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subjects | 692/699/75/243 692/700/1750 Blood pressure Cardiovascular disease Cardiovascular diseases Care and treatment Coronary artery disease Development and progression Diagnosis Epidemiology Health Administration Health risk assessment Heart diseases Hypertension Medicine Medicine & Public Health Morbidity Prognosis Public Health Risk factors |
title | Cardiovascular morbidity of severe resistant hypertension among treated uncontrolled hypertensives: a 4-year follow-up study |
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