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KMID : 1143420220150201342
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Public Health Weekly Report
2022 Volume.15 No. 20 p.1342 ~ p.1351
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Prevalence and prognosis of refractory hypertension diagnosed using ambulatory blood pressure measurements
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Yoon Min-Jae
Lee Chan-Joo
Park Sung-Ha
Lee Joung-Won
Lee Seung-Hee
Kim Won-Ho
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Abstract
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The prognosis of refractory hypertension is largely unknown due to its low prevalence. This study aimed to investigate the
prognosis of refractory hypertension and compare it with those of resistant and non-resistant hypertension. We retrospectively analyzed the data of 16,284 participants with hypertension who underwent ambulatory blood pressure (BP) monitoring between 2012 and 2019 at a tertiary center. Uncontrolled BP was defined as a 24-h BP ≥130/80 mmHg on
ambulator y BP monitoring. Resist ant hyper tension was defined as uncontrolled BP despite the use of three antihypertensive medications including a diuretic or the use of ≥4 drugs regardless of BP control. Refractory hypertension was defined as uncontrolled BP despite the use of ≥5 antihypertensive medications. Among 16,284 patients with hypertension (mean age 59.2 ± 15.5 years, 52.7% men), the patients with resistant and refractory hypertension were 1501 (9.2%) and 150 (0.9%), respectively. The prevalence of chronic kidney disease, end-stage renal disease, heart failure, previous stroke, left ventricular hypertrophy, and the riser/non-dipper patterns of circadian BP rhythm progressively
increased from patients with non-resistant hypertension to patients with resistant hypertension to patients with
refractory hypertension. During a median follow-up of 3.9 years, the risk of cardiovascular mortality progressively increased from patients with non-resistant hypertension to patients with resistant hypertension (hazard ratio 1.62, 95% confidence interval 1.16?2.26) to patients with refractory hypertension (hazard ratio 5.22, 95% confidence interval 3.04?8.96). In conclusion, refractory hypertension, defined as uncontrolled ambulatory BP levels, was associated with higher risk of allcause and cardiovascular mortality than non-resistant or resistant hypertension.
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KEYWORD
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Ambulatory blood pressure monitoring, Cardiovascular death, Resistant hypertension, Refractory hypertension
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