期刊
JOURNAL OF THE AMERICAN HEART ASSOCIATION
卷 3, 期 1, 页码 -出版社
WILEY
DOI: 10.1161/JAHA.113.000660
关键词
hypertension; resistant hypertension; WISE; women
资金
- National Heart, Lung and Blood Institutes [N01-HV-68161, N01-HV-68162, N01-HV-68163, N01-HV-68164]
- National Institute on Aging [U0164829, U01 HL649141, U01 HL649241, T32HL69751, R01 HL090957, 1R03AG032631]
- GCRC from the National Center for Research Resources [MO1-RR00425]
- National Center for Advancing Translational Sciences [UL1TR000124]
- Gustavus and Louis Pfeiffer Research Foundation, Danville, NJ
- Women's Guild of Cedars-Sinai Medical Center, Los Angeles, CA
- Ladies Hospital Aid Society of Western Pennsylvania, Pittsburgh, PA
- QMED, Inc., Laurence Harbor, NJ
- Edythe L. Broad Women's Heart Research Fellowship
- Cedars-Sinai Medical Center, Los Angeles, CA
- Barbra Streisand Women's Cardiovascular Research and Education Program
- Society for Women's Health Research (SWHR), Washington, DC
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.
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