Official websites use .gov
A
.gov
website belongs to an official government organization in the
United States.
Secure .gov websites use HTTPS
A
lock
(
) or
https://
means you’ve safely connected to the .gov website. Share sensitive
information only on official, secure websites.
PubMed ID:
33161774
Public Release Type:
Journal
Publication Year: 2021
Affiliation: From the Department of Internal Medicine (M.G.B., A.B.), Southern Illinois University School of Medicine, Springfield, IL.; Division of General Internal Medicine, Hypertension Section, Department of Internal Medicine (V.P., B.A., J.M.F.), Southern Illinois University School of Medicine, Springfield, IL.; From the Department of Internal Medicine (M.G.B., A.B.), Southern Illinois University School of Medicine, Springfield, IL.; Division of General Internal Medicine, Hypertension Section, Department of Internal Medicine (V.P., B.A., J.M.F.), Southern Illinois University School of Medicine, Springfield, IL.; Renal-Electrolyte and Hypertension Division (J.B.C.).; Division of Nephrology, Department of Medicine, Case Western Reserve University, Cleveland, OH (M.R.).; Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (M.R.W.).; Division of Nephrology, Department of Medicine, University of Illinois at Chicago, Chicago, IL (A.C.R.).; Center for Clinical Research (M.G.B., A.B.), Southern Illinois University School of Medicine, Springfield, IL.
DOI:
https://doi.org/10.1161/HYPERTENSIONAHA.120.15064
Authors:
Buhnerkempe Michael G, Prakash Vivek, Botchway Albert, Adekola Bemi, Cohen Jordana B, Rahman Mahboob, Weir Matthew R, Ricardo Ana C, Flack John M
Request IDs:
21986
Studies:
Chronic Renal Insufficiency Cohort Study
Refractory hypertension (RfH) is a severe phenotype of antihypertension treatment failure. Treatment-resistant hypertension (TRH), a less severe form of difficult-to-treat hypertension, has been associated with significantly worse health outcomes. However, no studies currently show how health outcomes may worsen upon progression to RfH. RfH and TRH were studied in 3147 hypertensive participants in the CRIC (Chronic Renal Insufficiency Cohort study). The hypertensive phenotype (ie, no TRH or RfH, TRH, or RfH) was identified at the baseline visit, and health outcomes were monitored at subsequent visits. Outcome risk was compared using Cox proportional hazards models with time-varying covariates. A total of 136 (4.3%) individuals were identified with RfH at baseline. After adjusting for participant characteristics, individuals with RfH had increased risk for the composite renal outcome across all study years (50% decline in estimated glomerular filtration rate or end-stage renal disease; hazard ratio for study years 0-10=1.73 [95% CI, 1.42-2.11]) and the composite cardiovascular disease outcome during later study years (stroke, myocardial infarction, or congestive heart failure; hazard ratio for study years 0-3=1.25 [0.91-1.73], for study years 3-6=1.50 [0.97-2.32]), and for study years 6-10=2.72 [1.47-5.01]) when compared with individuals with TRH. There was no significant difference in all-cause mortality between those with refractory versus TRH. We provide the first evidence that RfH is associated with worse long-term health outcomes compared with TRH.
