Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Terrassa, Spain (A.d.l.S.).
Hypertension Unit and Cardiorenal Translational Laboratory, Hospital 12 de Octubre, Madrid, Spain (L.M.R., J.S.).
Hypertension. 2024 Nov;81(11):2350-2356. doi: 10.1161/HYPERTENSIONAHA.124.23276. Epub 2024 Sep 9.
Resistant hypertension is characterized by elevated blood pressure (BP) despite using 3 antihypertensive agents. Ambulatory BP monitoring (ABPM) detects the presence of white-coat resistant hypertension (24-hour BP <130/80 mm Hg). The aim of the study was to evaluate risks of death in resistant hypertension compared with controlled hypertension, as well as in ABPM-confirmed (24-hour BP ≥130 or 80 mm Hg), versus white-coat resistant hypertension.
We selected 8146 patients with controlled hypertension (office BP <140/90 mm Hg while being treated with ≤3 antihypertensive drugs) and 8577 with resistant hypertension (BP ≥140 or ≥90 mm Hg while being treated with ≥3 drugs). All-cause and cardiovascular mortalities (median follow-up, 9.7 years) were compared between groups, as well as between patients with white-coat (3289) and ABPM-confirmed (5288) resistant hypertension. Hazard ratios (HRs) from Cox models after adjustment for clinical confounders were used for comparisons.
Compared with controlled hypertension, resistant hypertension was associated with an increased risk in all-cause (HR, 1.21 [95% CI, 1.12-1.30]) and cardiovascular mortalities (HR, 1.33 [95% CI, 1.17-1.51]) in confounder-adjusted models. Compared with white-coat, ABPM-confirmed resistant hypertension was associated with an increased risk of all-cause (HR, 1.45 [95% CI, 1.32-1.60]) and cardiovascular (HR, 1.68 [95% CI, 1.43-1.98]) mortalities. When ABPM-confirmed and white-coat resistant hypertension were separately compared with controlled hypertension, only the former was associated with an increased risk of death and cardiovascular death (HR, 1.36 [95% CI, 1.26-1.48] and 1.56 [95% CI, 1.36-1.79]), respectively.
ABPM-confirmed resistant hypertension is associated with an increased risk of death and cardiovascular death with respect to both controlled hypertension and white-coat resistant hypertension.
尽管使用了 3 种降压药物，高血压仍然存在，这被称为耐药性高血压。动态血压监测（ABPM）可检测出白大衣耐药性高血压（24 小时血压<130/80mmHg）的存在。本研究旨在评估耐药性高血压与控制良好的高血压相比以及与 ABPM 确诊（24 小时血压≥130 或 80mmHg）相比与白大衣耐药性高血压相比，死亡风险。
我们选择了 8146 名控制良好的高血压患者（在接受≤3 种降压药物治疗时办公室血压<140/90mmHg）和 8577 名耐药性高血压患者（在接受≥3 种药物治疗时血压≥140 或≥90mmHg）。比较两组之间的全因和心血管死亡率（中位随访时间为 9.7 年），以及白大衣（3289 例）和 ABPM 确诊（5288 例）耐药性高血压患者之间的死亡率。使用 Cox 模型调整临床混杂因素后的风险比（HR）用于比较。
与控制良好的高血压相比，调整混杂因素后，耐药性高血压与全因（HR，1.21[95%CI，1.12-1.30]）和心血管死亡率（HR，1.33[95%CI，1.17-1.51]）的风险增加相关。与白大衣相比，ABPM 确诊的耐药性高血压与全因（HR，1.45[95%CI，1.32-1.60]）和心血管（HR，1.68[95%CI，1.43-1.98]）死亡率的风险增加相关。当单独比较 ABPM 确诊的耐药性高血压和白大衣耐药性高血压与控制良好的高血压时，只有前者与死亡和心血管死亡的风险增加相关（HR，1.36[95%CI，1.26-1.48]和 1.56[95%CI，1.36-1.79]）。
ABPM 确诊的耐药性高血压与控制良好的高血压和白大衣耐药性高血压相比，与死亡和心血管死亡的风险增加相关。
