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  • Wijkman, MagnusLinköpings universitet,Medicinska fakulteten,Avdelningen för diagnostik och specialistmedicin,Region Östergötland, Medicinkliniken ViN,Harvard Med Sch, MA 02115 USA (author)

Resistance to antihypertensive treatment and long-term risk: The Atherosclerosis Risk in Communities study

  • Article/chapterEnglish2021

Publisher, publication year, extent ...

  • 2021-09-21
  • Wiley,2021
  • electronicrdacarrier

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  • LIBRIS-ID:oai:DiVA.org:liu-179624
  • https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-179624URI
  • https://doi.org/10.1111/jch.14269DOI

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  • Language:English
  • Summary in:English

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  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

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  • Funding Agencies|National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human ServicesUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Heart Lung & Blood Institute (NHLBI) [HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I]; Swedish Heart Association, Sweden; Swedish Society of Medicine, Sweden; Region Ostergotland, Sweden; NIH/NHLBIUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Heart Lung & Blood Institute (NHLBI) [R01HL135008, R01HL143224, R01HL150342, R01HL148218, K24HL152008]
  • More stringent blood pressure (BP) goals have led to greater prevalence of apparent resistant hypertension (ARH), yet the long-term prognostic impact of ARH diagnosed according to these goals in the general population remains unknown. We assessed the prognostic impact of ARH according to contemporary BP goals in 9612 participants of the Atherosclerosis Risk in Communities (ARIC) study without previous cardiovascular disease. ARH, defined as BP above goal (traditional goal <140/90 mmHg, more stringent goal <130/80 mmHg) despite the use of >= 3 antihypertensive drug classes or any BP with >= 4 antihypertensive drug classes (one of which was required to be a diuretic) was compared with controlled hypertension (BP at goal with 1-3 antihypertensive drug classes). Cox regression models were adjusted for age, sex, race, study center, BMI, heart rate, smoking, eGFR, LDL, HDL, triglycerides, and diabetes. Using the traditional BP goal, 133 participants (3.8% of the treated) had ARH. If the more stringent BP goal was instead applied, 785 participants (22.6% of the treated) were reclassified from controlled hypertension to uncontrolled hypertension (n = 725) or to ARH (n = 60). Over a median follow-up time of 19 years, ARH was associated with increased risk for a composite end point (all-cause mortality, hospitalization for myocardial infarction, stroke, or heart failure) regardless of whether traditional (adjusted HR 1.50, 95% CI: 1.23-1.82) or more stringent (adjusted HR 1.43, 95% CI: 1.20-1.70) blood pressure goals were applied. We conclude that in patients free from cardiovascular disease, ARH predicted long-term risk regardless of whether traditional or more stringent BP criteria were applied.

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  • Malachias, Marcus V. B.Fundacao Educ Lucas Machado, Brazil (author)
  • Claggett, Brian L.Harvard Med Sch, MA 02115 USA (author)
  • Cheng, SusanCedars Sinai Med Ctr, CA 90048 USA (author)
  • Matsushita, KunihiroJohns Hopkins Univ, MD USA (author)
  • Shah, Amil M.Harvard Med Sch, MA 02115 USA (author)
  • Jhund, Pardeep S.Univ Glasgow, Scotland (author)
  • Coresh, JosefJohns Hopkins Univ, MD USA (author)
  • Solomon, Scott D.Harvard Med Sch, MA 02115 USA (author)
  • Vardeny, OrlyMinneapolis VA Hlth Care Syst, MN USA; Univ Minnesota, MN USA (author)
  • Linköpings universitetMedicinska fakulteten (creator_code:org_t)

Related titles

  • In:The Journal of Clinical Hypertension: Wiley23:10, s. 1887-18961524-61751751-7176

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