BACKGROUND Resistant hypertension is characterized by elevated blood pressure (BP) despite using 3 antihypertensive agents. Ambulatory BP monitoring (ABPM) detects the presence of white-coat resistant hypertension (24-hour BP <130/80 mm Hg). The aim of the study was to evaluate risks of death in resistant hypertension compared with controlled hypertension, as well as in ABPM-confirmed (24-hour BP ≥130 or 80 mm Hg), versus white-coat resistant hypertension. METHODS We selected 8146 patients with controlled hypertension (office BP <140/90 mm Hg while being treated with ≤3 antihypertensive drugs) and 8577 with resistant hypertension (BP ≥140 or ≥90 mm Hg while being treated with ≥3 drugs). All-cause and cardiovascular mortalities (median follow-up, 9.7 years) were compared between groups, as well as between patients with white-coat (3289) and ABPM-confirmed (5288) resistant hypertension. Hazard ratios (HRs) from Cox models after adjustment for clinical confounders were used for comparisons. RESULTS Compared with controlled hypertension, resistant hypertension was associated with an increased risk in all-cause (HR, 1.21 [95% CI, 1.12-1.30]) and cardiovascular mortalities (HR, 1.33 [95% CI, 1.17-1.51]) in confounder-adjusted models. Compared with white-coat, ABPM-confirmed resistant hypertension was associated with an increased risk of all-cause (HR, 1.45 [95% CI, 1.32-1.60]) and cardiovascular (HR, 1.68 [95% CI, 1.43-1.98]) mortalities. When ABPM-confirmed and white-coat resistant hypertension were separately compared with controlled hypertension, only the former was associated with an increased risk of death and cardiovascular death (HR, 1.36 [95% CI, 1.26-1.48] and 1.56 [95% CI, 1.36-1.79]), respectively. CONCLUSIONS ABPM-confirmed resistant hypertension is associated with an increased risk of death and cardiovascular death with respect to both controlled hypertension and white-coat resistant hypertension.

中文翻译：

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顽固性高血压和死亡率：一项观察性队列研究。


背景 难治性高血压的特征是尽管使用了 3 种抗高血压药物，但血压 （BP） 升高。动态血压监测 （ABPM） 检测是否存在白衣抵抗性高血压 （24 小时 BP <130/80 mm Hg）。该研究的目的是评估难治性高血压与控制性高血压相比，以及 ABPM 确认的 （24 小时血压≥130 或 80 毫米汞柱） 与白大衣抵抗性高血压相比的死亡风险。方法 我们选择了 8146 例控制性高血压患者 （诊室血压 <140/90 mm Hg，接受 ≤3 种抗高血压药物治疗）和 8577 例难治性高血压患者 （血压 ≥140 或 ≥90 mm Hg，接受 ≥3 药物治疗）。比较各组之间以及白大衣 （3289） 和 ABPM 确诊 （5288） 顽固性高血压患者之间的全因死亡率和心血管死亡率 （中位随访，9.7 年）。使用调整临床混杂因素后来自 Cox 模型的风险比 （HRs） 进行比较。结果 与控制性高血压相比，在混杂因素调整模型中，难治性高血压与全因 （HR， 1.21 [95% CI， 1.12-1.30]） 和心血管死亡率 （HR， 1.33 [95% CI， 1.17-1.51]） 风险增加相关。与白大衣相比，ABPM 证实的顽固性高血压与全因 （HR， 1.45 [95% CI， 1.32-1.60]） 和心血管 （HR， 1.68 [95% CI， 1.43-1.98]） 死亡风险增加相关。当 ABPM 确诊的高血压和白大衣抵抗性高血压与控制性高血压分别进行比较时，只有前者与死亡和心血管死亡风险增加相关 （HR，分别为 1.36 [95% CI，1.26-1.48] 和 1.56 [95% CI，1.36-1.79]）。 结论 ABPM 证实的顽固性高血压与控制性高血压和白大衣抵抗性高血压的死亡和心血管死亡风险增加相关。