Lee Chan Joo, Lee Hokyou, Seo Jiwon, Hwang Jinseub, Kang Dayoung, Park Soo-Hyun, Hwang Jin-Taek, Park Jae Ho, Park Sungha
Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, Republic of Korea.
Hypertens Res. 2025 Jan;48(1):49-59. doi: 10.1038/s41440-024-01988-x. Epub 2024 Nov 14.
Large-scale studies of the prognosis of resistant hypertension in Asian populations are limited, and the impact of poor adherence on clinical prognosis in patients with apparent treatment-resistant hypertension has not been studied. A nationwide cohort analysis was done utilizing the National Health Insurance Service database in Korea, covering patients who participated in health examinations from 2013 to 2018. A total of 935,002 patients were classified into apparent treatment-resistant (N = 69,372) or nonresistant (N = 865,630) hypertension based on blood pressure control and antihypertensive medication use. Medication adherence was assessed using the proportion of days covered. The primary composite outcome included all-cause mortality, myocardial infarction, stroke, and heart failure. Other outcomes were the development of atrial fibrillation and progression to end-stage renal disease (ESRD). The median follow-up duration was 6.0 (interquartile range [IQR], 4.1-7.0) years. Patients with apparent treatment-resistant hypertension were at a higher risk for the primary composite outcome than those with nonresistant hypertension (hazard ratio [HR], 1.32; 95% confidence interval [CI], 1.29-1.35). The incidence rates of ESRD were notably higher in the resistant hypertension group (HR, 3.02; 95% CI, 2.85-3.20). Among participants with resistant hypertension, 3852 (5.7%), 11,667 (17.3%), and 51,879 (77%) had poor, suboptimal, and optimal adherence, respectively. Poor medication adherence in apparent treatment-resistant hypertension was associated with a higher risk of the primary composite outcome compared to optimal adherence (HR, 1.49; 95% CI, 1.36-1.63). Apparent treatment-resistant hypertension is associated with significant cardiovascular risks in the Korean population. Poor adherence to antihypertensive medication significantly elevates the risk of adverse clinical outcomes in patients with apparent treatment-resistant hypertension, underscoring the need for stringent management of these patients.
关于亚洲人群难治性高血压预后的大规模研究有限，且尚未研究依从性差对明显难治性高血压患者临床预后的影响。利用韩国国民健康保险服务数据库进行了一项全国性队列分析，涵盖2013年至2018年参加健康检查的患者。根据血压控制情况和抗高血压药物使用情况，共935,002例患者被分为明显难治性高血压（N = 69,372）或非难治性高血压（N = 865,630）。使用覆盖天数比例评估药物依从性。主要复合结局包括全因死亡率、心肌梗死、中风和心力衰竭。其他结局是心房颤动的发生和进展至终末期肾病（ESRD）。中位随访时间为6.0（四分位间距[IQR]，4.1 - 7.0）年。明显难治性高血压患者发生主要复合结局的风险高于非难治性高血压患者（风险比[HR]，1.32；95%置信区间[CI]，1.29 - 1.35）。ESRD的发病率在难治性高血压组显著更高（HR，3.02；95% CI，2.85 - 3.20）。在难治性高血压参与者中，分别有3852例（5.7%）、11,667例（17.3%）和51,879例（77%）依从性差、依从性一般和依从性良好。与良好依从性相比，明显难治性高血压患者中药物依从性差与发生主要复合结局的风险更高相关（HR，1.49；95% CI，1.36 - 1.63）。在韩国人群中，明显难治性高血压与显著的心血管风险相关。抗高血压药物依从性差显著增加了明显难治性高血压患者不良临床结局的风险，强调了对这些患者进行严格管理的必要性。
