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Cardiovascular medicine
Research
Prevalence and clinical characteristics of apparent therapy-resistant hypertension in patients with cardiovascular disease: a cross-sectional cohort study in secondary care
  1. Esther de Beus1,
  2. Nicolette G C van der Sande2,
  3. Michiel L Bots3,
  4. Wilko Spiering2,
  5. Michiel Voskuil4,
  6. Frank L J Visseren2,
  7. Peter J Blankestijn1
  1. 1 Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
  2. 2 Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
  3. 3 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
  4. 4 Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
  1. Correspondence to Dr Peter J Blankestijn; P.J.Blankestijn{at}umcutrecht.nl

Abstract

Objectives Our aim was to investigate the prevalence of apparent therapy-resistant hypertension (aTRH) in patients with clinical manifest cardiovascular disease (CVD), and to study clinical characteristics related to aTRH in this population.

Setting The SMART (Second Manifestations of ARTerial disease) study is a large, single-centre cohort study in secondary care.

Participants Office blood pressure (BP) at inclusion was used to evaluate BP control in 6191 hypertensive patients with clinical manifest (cardio)vascular disease. Therapy-resistant hypertension was defined as BP ≥140/90 mm Hg despite use of antihypertensive drugs from ≥3 drug classes including a diuretic or use of ≥4 antihypertensive drugs irrespective of BP. Logistic regression analysis was used to explore the relationship between clinical characteristics measured at baseline and presence of aTRH.

Results The prevalence of aTRH was 9.1% (95% CI 8.4 to 9.8). Prevalence increased with age and when albuminuria was present and was higher in patients with lower estimated glomerular filtration rate (eGFR). Presence of aTRH was related to diabetes, female sex, duration and multiple locations of vascular disease, body mass index and waist circumference. Carotid intima-media thickness was higher (0.99±0.28 vs 0.93±0.28 mm) and ankle-brachial index lower (1.07±0.20 vs 1.10±0.19) in patients with aTRH compared with patients without aTRH.

Conclusion aTRH is prevalent in patients with clinical manifest CVD and is related to clinical factors known to be related with increased vascular risk, and with lower eGFR.

  • Hypertension
  • Epidemiology
  • Nephrology
  • Vascular medicine
  • Cardiology
  • Internalmedicine

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2017-016692

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    Footnotes

    • Contributors FLJV is involved in the design, data collection and coordination of the SMART study as a whole, representing the SMART study team. The other members of the SMART study group read the manuscript and fully agreed with publication. EdB, PJB, FLJV and MLB were the initiators of this substudy. EdB and MLB carried out the analyses. EdB, NGCvdS, PJB, FLJV and MLB interpreted the results. EdB drafted the manuscript. All authors reviewed the manuscript, revised for important intellectual content and approved the final version.

    • Funding SMART study: grant from the University Medical Center Utrecht, The Netherlands. EdB: grant from The Netherlands Organisation for Health Research and Development (ZonMw).

    • Competing interests None declared.

    • Ethics approval Medical Ethics Committee of the Utrecht University Medical Center.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data used in this study can be accessed by contacting FLJV at F.L.J.Visseren@umcutrecht.nl.