Mortality Risk Associated With Resistant Hypertension Among Women: Analysis from Three Prospective Cohorts Encompassing the Spectrum of Women's Heart Disease

J Womens Health (Larchmt). 2016 Oct;25(10):996-1003. doi: 10.1089/jwh.2015.5609. Epub 2016 May 25.


Background: Women are at greater risk of developing resistant hypertension (RH) than men, yet scarce data exist on RH-associated outcomes in women. We aimed to determine all-cause mortality risk associated with apparent RH (aRH) among women across the spectrum of underlying coronary disease.

Materials and methods: We analyzed data from St. James Women Take Heart (WTH; women without coronary disease at baseline), Women's Ischemia Syndrome Evaluation (women with signs/symptoms of ischemia at baseline), and the INternational VErapamil-Trandolapril STudy (INVEST; women with coronary artery disease and hypertension at baseline), totaling 15,108 adult women with no hypertension, non-RH (blood pressure [BP] ≥140/90 mmHg on ≤2 drugs or BP <140/90 mmHg on 1-3 drugs), or aRH (BP ≥140/90 mmHg on ≥3 drugs or anyone on ≥4 drugs) at baseline. The primary outcome was all-cause mortality.

Results: Prevalence of aRH ranged from 0.4% (WTH) to 10.6% (INVEST). Women with aRH, compared to those without, were older, more often black, and more likely to be obese or diabetic. Pooling all cohorts, risk for all-cause death was greater in women with aRH than in women with non-RH (adjusted HR 1.40; 95% CI 1.27-1.55) and women without hypertension (adjusted HR 2.34; 95% CI 1.76-3.11) over a median follow-up of 14.3 years.

Conclusions: aRH prevalence in women varies according to underlying coronary disease, and aRH is associated with a substantial, early, and sustained increased risk of all-cause death. Additional research into early recognition and prevention strategies for RH are needed, especially in black and older women, and those with known cardiovascular risk factors.

Keywords: INVEST; WISE; hypertension; mortality; resistant hypertension; women.

MeSH terms

  • Adult
  • Aged
  • Antihypertensive Agents / therapeutic use*
  • Blood Pressure / drug effects*
  • Coronary Artery Disease / complications
  • Drug Resistance*
  • Female
  • Humans
  • Hypertension / drug therapy*
  • Hypertension / mortality*
  • Indoles / therapeutic use*
  • Middle Aged
  • Myocardial Ischemia / complications
  • Obesity / epidemiology
  • Prospective Studies
  • Risk Factors
  • Stroke / epidemiology
  • Treatment Outcome
  • United States / epidemiology
  • Verapamil / therapeutic use*


  • Antihypertensive Agents
  • Indoles
  • trandolapril
  • Verapamil