Xia J H, Wang X Y, Kang Y Y, Huang J F, Guo Q H, Cheng Y B, Li Y, Wang J G
Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2024 Aug 24;52(8):884-891. doi: 10.3760/cma.j.cn112148-20240415-00204.
To investigate the prevalence and associated risk of cardiovascular event of resistant hypertension in treated outpatients. This study was a nationwide multi-center prospective cohort study. The participants were treated outpatients enrolled in the China Nationwide Ambulatory and Home Blood Pressure Registry study of 42 hospitals in 19 provinces across the country from August 2009 to October 2017. Apparent resistant hypertension was defined as uncontrolled office blood pressure (≥140/90 mmHg, 1 mmHg=0.133 kPa) in spite of the use of three antihypertensive drugs or controlled office blood pressure (<140/90 mmHg) with four antihypertensive drugs or more. Subjects diagnosed with uncontrolled office blood pressure were further subdivided as pseudo-resistant hypertension and true resistant hypertension based on 24 h ambulatory blood pressure monitoring. The primary endpoint was fatal and non-fatal cardiovascular and cerebrovascular events, which was a composite endpoint consisting of cardiovascular and cerebrovascular death, ischemic and hemorrhagic stroke, myocardial infarction, coronary artery revascularization, unstable angina, heart failure, and coronary artery stenosis≥50% confirmed by coronary angiography. Secondary outcomes included fatal and non-fatal stroke or cardiac events. Patients with controlled office blood pressure after taking only 1 or 2 antihypertensive drugs were included as control. Kaplan-Meier survival curves, log-rank test, and Cox proportional risk model were used to evaluate the risk of apparent refractory hypertension in relation to cardiovascular and cerebrovascular prognosis. A total of 2 782 treated hypertensive patients, aged (58.1±12.3) years were enrolled, including 1 403 (50.4%) men. The prevalence of apparent and true resistant hypertension was 15.1% (420/2 782) and 10.5% (293/2 782), respectively. Among patients with apparent resistant hypertension, during a median of 5 years follow-up, the cumulative incidence rate was 28.2, 11.2 and 19.1 per 1 000 person-years for fatal and non-fatal cardiovascular events (=58), stroke (=24) and cardiac events (=40), respectively. The Kaplan-Meier curve and log-rank test showed that those patients with true resistant hypertension, had the highest cumulative incidence rate of fatal and non-fatal cardiovascular events, stroke, and cardiac events. Multivariable Cox regression analyses showed that true resistant hypertension was associated with a significantly higher risk of fatal and non-fatal cardiovascular events (=1.73, 95% 1.17-2.56, =0.006) and stroke (2.81, 95% 1.53-5.17, =0.001). Resistant hypertension, especially true resistant hypertension, is associated with a higher risk of fatal and non-fatal cardiac and cerebrovascular events.
为调查接受治疗的门诊患者中难治性高血压的患病率及相关心血管事件风险。本研究为一项全国性多中心前瞻性队列研究。研究对象为2009年8月至2017年10月期间纳入全国19个省份42家医院的中国全国门诊及家庭血压登记研究的接受治疗的门诊患者。显性难治性高血压定义为尽管使用了三种抗高血压药物但诊室血压仍未得到控制（≥140/90 mmHg，1 mmHg = 0.133 kPa），或使用四种或更多抗高血压药物时诊室血压得到控制（<140/90 mmHg）。被诊断为诊室血压未得到控制的受试者根据24小时动态血压监测进一步细分为假性难治性高血压和真性难治性高血压。主要终点为致命性和非致命性心血管和脑血管事件，这是一个复合终点，包括心血管和脑血管死亡、缺血性和出血性卒中、心肌梗死、冠状动脉血运重建、不稳定型心绞痛、心力衰竭以及经冠状动脉造影证实的冠状动脉狭窄≥50%。次要结局包括致命性和非致命性卒中或心脏事件。仅服用1或2种抗高血压药物后诊室血压得到控制的患者被纳入作为对照。采用Kaplan-Meier生存曲线、对数秩检验和Cox比例风险模型来评估显性难治性高血压与心血管和脑血管预后相关的风险。共纳入2782例接受治疗的高血压患者，年龄为（58.1±12.3）岁，其中男性1403例（50.4%）。显性和真性难治性高血压的患病率分别为15.1%（420/2782）和10.5%（293/2782）。在显性难治性高血压患者中，中位随访5年期间，致命性和非致命性心血管事件（=58）、卒中（=24）和心脏事件（=40）的累积发病率分别为每1000人年28.2、11.2和19.1。Kaplan-Meier曲线和对数秩检验显示，真性难治性高血压患者的致命性和非致命性心血管事件、卒中和心脏事件的累积发病率最高。多变量Cox回归分析显示，真性难治性高血压与致命性和非致命性心血管事件（=1.73，95% 1.17-2.56，=0.006）和卒中（2.81，95% 1.53-5.17，=0.001）的风险显著升高相关。难治性高血压，尤其是真性难治性高血压，与致命性和非致命性心脑血管事件的较高风险相关。
