Cardiovascular and mortality risk of apparent resistant hypertension in women with suspected myocardial ischemia: a report from the NHLBI-sponsored WISE Study

J Am Heart Assoc. 2014 Feb 28;3(1):e000660. doi: 10.1161/JAHA.113.000660.

Abstract

Background: Women are more likely than men to develop resistant hypertension, which is associated with excess risk of major adverse outcomes; however, the impact of resistant hypertension in women with ischemia has not been explicitly studied. In this Women's Ischemia Syndrome Evaluation (WISE) analysis, we assessed long-term adverse outcomes associated with apparent treatment-resistant hypertension (aTRH) among women with suspected myocardial ischemia referred for coronary angiography.

Methods and results: Women (n=927) were grouped according to baseline blood pressure (BP): normotensive (no hypertension history, BP <140/90 mm Hg, no antihypertensive drugs); controlled (BP <140/90 mm Hg and a hypertension diagnosis or on 1 to 3 drugs); uncontrolled (BP ≥140/90 mm Hg on ≤2 drugs); or aTRH (BP ≥140/90 mm Hg on 3 drugs or anyone on ≥4 drugs). Adverse outcomes (first occurrence of death [any cause], nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure or angina) were collected over 10 years of follow-up. Apparent treatment-resistant hypertension prevalence was 10.4% among those with hypertension. Women with aTRH had a greater incidence of adverse outcomes, compared with normotensive women (adjusted hazard ratio [HR], 3.25; 95% confidence interval [CI], 1.94 to 5.43), and women with controlled (HR, 1.77; 95% CI, 1.26 to 2.49) and uncontrolled (HR, 1.62; 95% CI, 1.15 to 2.27) hypertension; outcome differences were evident early in follow-up. Risk of all-cause death was greater in the aTRH group, compared to the normotensive women and women with controlled and uncontrolled hypertension.

Conclusions: In this cohort of women with evidence of ischemia, aTRH was associated with a profoundly increased long-term risk of major adverse events, including death, that emerged early during follow-up.

Keywords: WISE; hypertension; resistant hypertension; women.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Angina Pectoris / epidemiology
  • Antihypertensive Agents / therapeutic use*
  • Blood Pressure / drug effects*
  • Coronary Angiography
  • Drug Resistance*
  • Drug Therapy, Combination
  • Female
  • Heart Failure / epidemiology
  • Hospitalization
  • Humans
  • Hypertension / diagnosis
  • Hypertension / drug therapy*
  • Hypertension / epidemiology*
  • Hypertension / mortality
  • Kaplan-Meier Estimate
  • Middle Aged
  • Myocardial Infarction / epidemiology
  • Myocardial Ischemia / diagnosis
  • Myocardial Ischemia / epidemiology*
  • Myocardial Ischemia / mortality
  • National Heart, Lung, and Blood Institute (U.S.)
  • Prognosis
  • Proportional Hazards Models
  • Risk Factors
  • Sex Factors
  • Stroke / epidemiology
  • Time Factors
  • United States / epidemiology

Substances

  • Antihypertensive Agents