Denisova A R, Solntseva T D, Zarmanbetova A S, Tkacheva A A, Sivakova O A, Chazova I Е
National Medical Research Center of Cardiology.
Ter Arkh. 2022 Jan 15;94(1):94-99. doi: 10.26442/00403660.2022.01.201395.
To assess the incidence of cardiovascular and cerebrovascular events in patients with controlled and uncontrolled hypertension, controlled resistant and uncontrolled resistant hypertension, refractory hypertension, and probably resistant and probably refractory hypertension.
A telephone call was made to 256 patients with hypertension included in the database to assess the incidence of cardiovascular and cerebrovascular diseases. All responding patients were divided into 7 groups according to the classification of hypertension based on the achievement/non-achievement of target blood pressure values and the number of drugs taken (controlled and uncontrolled hypertension, controlled resistant and uncontrolled resistant hypertension, refractory hypertension, and probably resistant and probably refractory hypertension). The target blood pressure was considered to be less than 140/90 mm Hg. Patients not adhering to medication were not included in the analysis.
The group of controlled hypertension included 146 (57%) patients out of 256, controlled resistant hypertension 36 (14%) patients, uncontrolled hypertension 6 (2.3%) patients, resistant uncontrolled hypertension 22 (8.6%) patients, refractory hypertension 31 (12.1%) patients. The group of probably resistant hypertension 6 (2.3%) patients, probably refractory hypertension 9 (3.5%) patients. Of the 28 events that occurred, 6 were attributed to coronary artery disease (including 3 acute myocardial infarction and 2 coronary artery stenting), 3 strokes, 6 episodes of transient ischemic attack and 10 new cases of atrial fibrillation, and 2 patients had sudden cardiac death. Significantly more often, patients with refractory hypertension developed any event compared with patients with controlled (38.7% versus 3.4%; p=0.005) and resistant hypertension (38.7% versus 13.6%; p=0.04). Also, patients from the group of probably refractory hypertension were more likely to develop events than patients with controlled hypertension (33.3% versus 3.4%; p=0.045). Patients with probably refractory hypertension significantly more often had a stroke than patients with controlled hypertension (22.2% versus 0%; p0.05), and patients with refractory hypertension significantly more often had a transient ischemic attack compared with patients from the group of controlled hypertension (12.9% versus 0.7%; p=0.03).
Patients with refractory and probably refractory hypertension are significantly more likely to develop cardiovascular and cerebrovascular complications than patients with controlled hypertension.
评估血压得到控制和未得到控制的高血压患者、顽固性高血压得到控制和未得到控制的患者、难治性高血压患者以及可能为顽固性和可能为难治性高血压患者发生心脑血管事件的发生率。
对数据库中纳入的256例高血压患者进行电话随访，以评估心脑血管疾病的发生率。所有有回应的患者根据基于目标血压值的达成情况及服用药物数量的高血压分类（血压得到控制和未得到控制的高血压、顽固性高血压得到控制和未得到控制的患者、难治性高血压以及可能为顽固性和可能为难治性高血压）分为7组。目标血压被认为低于140/90 mmHg。未坚持服药的患者未纳入分析。
256例患者中，血压得到控制的高血压组有146例（57%），顽固性高血压得到控制组有36例（14%），血压未得到控制的高血压组有6例（2.3%），顽固性高血压未得到控制组有22例（8.6%），难治性高血压组有31例（12.1%）。可能为顽固性高血压组有6例（2.3%），可能为难治性高血压组有9例（3.5%）。在发生的28起事件中，6起归因于冠状动脉疾病（包括3例急性心肌梗死和2例冠状动脉支架置入术），3例中风，6例短暂性脑缺血发作和10例新发房颤，2例患者发生心源性猝死。与血压得到控制的患者（38.7%对3.4%；p=0.005）和顽固性高血压患者（38.7%对13.6%；p=0.04）相比，难治性高血压患者发生任何事件的频率明显更高。此外，可能为难治性高血压组的患者比血压得到控制的患者更易发生事件（33.3%对3.4%；p=0.045）。可能为难治性高血压患者发生中风的频率明显高于血压得到控制的患者（22.2%对0%；p<0.05），难治性高血压患者发生短暂性脑缺血发作的频率明显高于血压得到控制组的患者（12.9%对0.7%；p=0.03）。
与血压得到控制的高血压患者相比，难治性和可能为难治性高血压患者发生心脑血管并发症的可能性明显更高。
