From the Department of Epidemiology (P.M.) and Cardiovascular Disease (D.A.C.), University of Alabama at Birmingham; Coordinating Center for Clinical Trials, The University of Texas School of Public Health, Houston (B.R.D., S.L.P.); Preventive Medicine Section, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Cardiovascular Outcomes Group, New York University School of Medicine (S.B.); New York University Langone Medical Center (H.R.B.); Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Clinical Trials Services Unit, University of Washington School of Medicine, Seattle (J.L.P.); Global Public Health, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Case Medical Center, Cleveland, OH (M.R.); and Louis Stokes Cleveland Veterans Administration Medical Center, Cleveland, OH (M.R.).
Hypertension. 2014 Nov;64(5):1012-21. doi: 10.1161/HYPERTENSIONAHA.114.03850. Epub 2014 Aug 4.
Apparent treatment-resistant hypertension (aTRH) is defined as uncontrolled hypertension despite the use of ≥3 antihypertensive medication classes or controlled hypertension while treated with ≥4 antihypertensive medication classes. Although a high prevalence of aTRH has been reported, few data are available on its association with cardiovascular and renal outcomes. We analyzed data on 14 684 Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) participants to determine the association between aTRH (n=1870) with coronary heart disease, stroke, all-cause mortality, heart failure, peripheral artery disease, and end-stage renal disease. We defined aTRH as blood pressure not at goal (systolic/diastolic blood pressure ≥140/90 mm Hg) while taking ≥3 classes of antihypertensive medication or taking ≥4 classes of antihypertensive medication with blood pressure at goal during the year 2 ALLHAT study visit (1996-2000). Use of a diuretic was not required to meet the definition of aTRH. Follow-up occurred through 2002. The multivariable adjusted hazard ratios (95% confidence intervals) comparing participants with versus without aTRH were as follows: coronary heart disease (1.44 [1.18-1.76]), stroke (1.57 [1.18-2.08]), all-cause mortality (1.30 [1.11-1.52]), heart failure (1.88 [1.52-2.34]), peripheral artery disease (1.23 [0.85-1.79]), and end-stage renal disease (1.95 [1.11-3.41]). aTRH was also associated with the pooled outcomes of combined coronary heart disease (hazard ratio, 1.47; 95% confidence interval, 1.26-1.71) and combined cardiovascular disease (hazard ratio, 1.46; 95% confidence interval, 1.29-1.64). These results demonstrate that aTRH increases the risk for cardiovascular disease and end-stage renal disease. Studies are needed to identify approaches to prevent aTRH and reduce risk for adverse outcomes among individuals with aTRH.
明显的治疗抵抗性高血压（aTRH）定义为尽管使用了≥3 种降压药物类别仍未控制的高血压，或尽管使用了≥4 种降压药物类别仍控制的高血压。尽管已经报道了 aTRH 的高患病率，但关于其与心血管和肾脏结局的关系的数据很少。我们分析了 14684 名抗高血压和降脂治疗预防心脏病发作试验（ALLHAT）参与者的数据，以确定 aTRH（n=1870）与冠心病、中风、全因死亡率、心力衰竭、外周动脉疾病和终末期肾病之间的关系。我们将 aTRH 定义为在服用≥3 种降压药物类别时血压未达标（收缩压/舒张压≥140/90mmHg），或在 ALLHAT 研究访问期间（1996-2000 年）服用≥4 种降压药物类别时血压达标。达到 aTRH 的定义不需要使用利尿剂。随访至 2002 年。与无 aTRH 相比，有 aTRH 的参与者的多变量调整风险比（95%置信区间）如下：冠心病（1.44[1.18-1.76]）、中风（1.57[1.18-2.08]）、全因死亡率（1.30[1.11-1.52]）、心力衰竭（1.88[1.52-2.34]）、外周动脉疾病（1.23[0.85-1.79]）和终末期肾病（1.95[1.11-3.41]）。aTRH 也与冠心病（危险比，1.47；95%置信区间，1.26-1.71）和心血管疾病（危险比，1.46；95%置信区间，1.29-1.64）的合并结局相关。这些结果表明，aTRH 增加了患心血管疾病和终末期肾病的风险。需要研究来确定预防 aTRH 和降低 aTRH 个体不良结局风险的方法。
