Grave prognosis for heart patients with treatment-resistant hypertension

By Eleanor McDermid, Senior medwireNews Reporter

Patients with coronary artery disease have a particularly high risk for poor outcomes if they have treatment-resistant hypertension, shows an analysis of the Treating to New Targets (TNT) trial.

In these trial participants, treatment-resistant hypertension was most likely to occur in those who were older, female, of Black race, had an increased body mass index, or had comorbidities such as diabetes, kidney disease, and previous myocardial infarction.

The study findings “emphasize the need to monitor these high-risk groups of patients carefully,” say lead researcher Sripal Bangalore (New York University School of Medicine, USA) and co-workers.

The team defined treatment-resistant hypertension as systolic blood pressure of at least 140 mmHg despite concurrent treatment with three different classes of antihypertensive, or the requirement for at least four medications to achieve controlled blood pressure.

All the 10,001 TNT participants had clinically apparent coronary heart disease, and 11.1% of these had treatment-resistant hypertension, with about two-thirds meeting the first definition and a third the second definition.

Bangalore et al note that no previous study has quantified treatment-resistant hypertension in this group of patients. “Given the shared pathophysiology of atherosclerosis as both a cause and a consequence of coronary artery disease and hypertension, this is all the more important,” they write in TheAmerican Journal of Medicine.

During a median follow-up of 4.9 years, patients with treatment-resistant hypertension were a significant 1.64-fold more likely than those without to have a major cardiovascular event, at respective rates of 17.2% and 8.9%. The increased risk was present for patients with treatment-resistant hypertension by both definitions.

The increase was driven by elevated rates of coronary heart disease death, at 4.8% versus 2.0%, and nonfatal myocardial infarction, at 9.6% versus 5.0%. Rates of stroke and resuscitated cardiac arrest did not significantly differ between the groups, although both were numerically more common among patients with treatment-resistant hypertension.

“Our data indicate the need for well-powered studies aimed not only to reduce the surrogate end point of blood pressure reduction but also to show a reduction in hard cardiovascular outcomes,” say the researchers.

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