Key points
Background
Methods
Study sample
BP, Antihypertensives and definition of treatment resistant hypertension
Measurements – other variables
Causes of death
Statistical analysis
Results
Baseline participant characteristics
Characteristica | Non-aTRH | aTRH | ||||
---|---|---|---|---|---|---|
Any Non-aTRH | Non-aTRH Subgroups | Any aTRH | aTRH Subgroups | |||
< 3 medications | 3 medications | Controlled | Uncontrolled | |||
Definition: BP mm Hg and number of antihypertensives | < 140/90 AND ≤3 | < 140/90 AND < 3 | < 140/90 AND 3 | > 140/90 OR ≥3 | < 140/90 AND ≥4 | ≥140/90 AND ≥3 |
Unweighted Population (N) | 4835 | 3837 | 998 | 1522 | 432 | 1090 |
US Weighted Population (N in Millions)b | 29.04 | 23.49 | 5.55 | 7.6 | 2.27 | 5.33 |
Age (years), mean (SE) | 59.4 (0.3) | 58.3 (0.3) | 64 (0.3) | 65.9 (0.5) | 65.1 (0.6) | 66.2 (0.8) |
Age Categories | ||||||
Age < 45 years | 510 (14.1) | 457 (15.5) | 53 (8) | 69 (5.9) | 14 (4.6) | 55 (6.5) |
Age 45–65 years | 2055 (48.8) | 1709 (51) | 346 (39.3) | 456 (35.5) | 138 (38.7) | 318 (34.2) |
Age ≥ 65 years | 2270 (37.1) | 1671 (33.4) | 599 (52.8) | 997 (58.5) | 280 (56.7) | 717 (59.3) |
Sex | ||||||
Female | 2607 (55.1) | 2094 (55.3) | 513 (54.2) | 819 (57.4) | 209 (52.5) | 610 (59.5) |
Male | 2228 (44.9) | 1743 (44.7) | 485 (45.8) | 703 (42.6) | 223 (47.5) | 480 (40.5) |
Race/Ethnicity | ||||||
Non-Hispanic White | 2645 (78.3) | 2073 (78.5) | 572 (77.3) | 787 (73.4) | 224 (74.4) | 563 (73) |
Non-Hispanic Black | 1221 (12.3) | 959 (12) | 262 (13.8) | 491 (18.3) | 147 (18.1) | 344 (18.4) |
Mexican American | 823 (5.4) | 685 (5.4) | 138 (5.7) | 210 (5) | 51 (4.7) | 159 (5.1) |
Other | 146 (4) | 120 (4.2) | 26 (3.3) | 34 (3.3) | 10 (2.8) | 24 (3.5) |
Ever or Current Smoker | 2643 (55.1) | 2077 (55.3) | 566 (53.8) | 838 (53.1) | 257 (58.4) | 581 (50.8) |
Diabetes | 1459 (24.5) | 1090 (22.7) | 369 (32.4) | 661 (39.5) | 210 (44.1) | 451 (37.5) |
Prior CVD | 1101 (18.9) | 750 (15.9) | 351 (31.4) | 636 (40.1) | 213 (48.5) | 423 (36.4) |
Body mass index (kg/m2), mean (SE) | 30.8 (0.1) | 30.6 (0.1) | 31.8 (0.3) | 32.1 (0.3) | 33.2 (0.5) | 31.7 (0.3) |
Systolic blood pressure (mmHg), mean (SE) | 122.2 (0.2) | 122.3 (0.2) | 121.7 (0.4) | 144.7 (0.7) | 119.7 (0.7) | 155.4 (0.6) |
Diastolic blood pressure (mmHg), mean (SE) | 69.6 (0.3) | 70.3 (0.3) | 66.6 (0.5) | 71.1 (0.5) | 63.6 (0.9) | 74.3 (0.6) |
# of anti-hypertensives, mean (SE) | 1.77 (0.01) | 1.48 (0.01) | 3 (0) | 3.67 (0.03) | 4.26 (0.03) | 3.41 (0.03) |
Diuretics | 2333 (46.3) | 1512 (37.5) | 821 (83.5) | 1310 (86.8) | 404 (93.5) | 906 (83.9) |
ACE-i or ARB | 2563 (63.4) | 1862 (59.8) | 701 (77.9) | 1115 (83.2) | 370 (89.3) | 745 (80.2) |
Calcium channel blockers | 1348 (24.5) | 890 (20.2) | 458 (43) | 892 (56.6) | 283 (65.1) | 609 (53) |
Beta blockers | 1555 (34.6) | 997 (29) | 558 (58.1) | 991 (66.6) | 326 (77.2) | 665 (62) |
Other | 481 (8) | 281 (5.7) | 200 (17.5) | 624 (38.1) | 211 (45.9) | 413 (34.7) |
Total Cholesterol (mmol/L), mean (SE) | 5.2 (0.02) | 5.2 (0.03) | 5.1 (0.05) | 5.2 (0.05) | 4.8 (0.08) | 5.3 (0.05) |
eGFR (mL/min/1.73 m2), median (IQR) | 82 (66, 96) | 84 (69, 97) | 71 (58, 87) | 68 (51, 85) | 67 (52, 86) | 68 (51, 85) |
CRP (mg/dL), mean (SE) | 0.56 (0.02) | 0.54 (0.02) | 0.65 (0.04) | 0.68 (0.03) | 0.67 (0.05) | 0.68 (0.04) |
ACR (mg/g), median (IQR) | 7 (5, 15) | 7 (5, 13) | 9 (5, 22) | 14 (6, 49) | 10 (6, 26) | 17 (7, 67) |
aTRH and risk of cardiovascular mortality
Unweighteda | Weightedb | Crude IRb (95% CI) Per 1000 PY | Model 1: Unadjustedc | Model 2d | Model 3e | Model 4: Fully Adjustedf | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
N (%) | Deaths (%) | N in millions (%) | Deaths in millions (%) | HR | p | HR | p | HR | p | HR | p | ||
Non-aTRH | 4835 (76.1) | 339 (7) | 29.04 (79.3) | 1.6 (5.5) | 7.4 (6.4, 8.5) | Reference | Reference | Reference | Reference | ||||
Any aTRH | 1522 (23.9) | 211 (13.9) | 7.6 (20.7) | 0.97 (12.8) | 19.4 (16.2, 23.4) | 2.69 (2.14, 3.4) | < 0.001 | 1.85 (1.47, 2.34) | < 0.001 | 1.73 (1.34, 2.23) | < 0.001 | 1.47 (1.1, 1.96) | 0.01 |
Controlled | 432 (6.8) | 45 (10.4) | 2.27 (6.2) | 0.22 (9.9) | 19.1 (13.1, 27.8) | 2.82 (1.91, 4.15) | < 0.001 | 2.06 (1.41, 3.03) | < 0.001 | 1.78 (1.12, 2.81) | 0.015 | 1.66 (1.03, 2.68) | 0.039 |
Uncontrolled | 1090 (17.1) | 166 (15.2) | 5.33 (14.5) | 0.75 (14.1) | 19.5 (16, 23.9) | 2.66 (2.07, 3.41) | < 0.001 | 1.8 (1.41, 2.29) | < 0.001 | 1.72 (1.32, 2.24) | < 0.001 | 1.43 (1.05, 1.94) | 0.025 |
p-trend | < 0.001 | p-trend | < 0.001 | p-trend | < 0.001 | p-trend | 0.017 |
Unweighteda | Weightedb | Crude IR (Weighted) | Model 1: Unadjustedc | Model 2d | Model 3e | Model 4: Fully Adjustedf | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
N (%) | Deaths (%) | N in millions (%) | Deaths in millions (%) | Per 1000 PY | HR | p | HR | p | HR | p | HR | p | |
Non-aTRH < 3 medications | 3837 (60.4) | 243 (6.3) | 23.49 (64.1) | 1.14 (4.9) | 6.3 (5.4, 7.5) | Reference | Reference | Reference | Reference | ||||
Non-aTRH 3 medications | 998 (15.7) | 96 (9.6) | 5.55 (15.1) | 0.46 (8.3) | 13 (9.9, 16.9) | 2.14 (1.55, 2.95) | < 0.001 | 1.59 (1.18, 2.16) | 0.003 | 1.57 (1.15, 2.15) | 0.005 | 1.35 (0.98, 1.86) | 0.064 |
All-cause mortality
Subgroup analyses
N | Deaths | Any aTRH vs. Controlled | p-interaction | |
---|---|---|---|---|
Age (years) | ||||
< 45 years | 579 | 15 | NA | 0.211 |
45–65 years | 2511 | 117 | 2.13 (1.18, 3.88) | |
≥ 65 years | 3267 | 418 | 1.23 (0.91, 1.66) | |
Sex | ||||
Female | 3426 | 269 | 1.87 (1.26, 2.79) | 0.033 |
Male | 2931 | 281 | 1.13 (0.76, 1.69) | |
Race/Ethnicity | ||||
Non-Hispanic White | 3432 | 343 | 1.56 (1.13, 2.15) | |
Non-Hispanic Black | 1712 | 143 | 1.17 (0.73, 1.88) | 0.583 |
Mexican American | 1033 | 58 | 1.15 (0.38, 3.43) | |
Other | 180 | 6 | NA | |
Nonsmoker | 2869 | 218 | 2.16 (1.34, 3.47) | 0.075 |
Smoker | 3481 | 332 | 1.19 (0.85, 1.65) | |
No Diabetes | 4237 | 349 | 1.48 (1.05, 2.07) | 0.746 |
Diabetes | 2120 | 201 | 1.46 (0.94, 2.28) | |
No CVD | 4558 | 261 | 1.68 (1.1, 2.56) | 0.03 |
CVD | 1737 | 282 | 1.35 (1, 1.81) | |
No Diuretic | 2714 | 161 | 1.223 (0.62, 2.4) | 0.818 |
Diuretic | 3643 | 389 | 1.48 (1.04, 2.11) | |
No ACE-I or ARB | 1705 | 101 | 1.35 (0.69, 2.62) | 0.562 |
ACE-I or ARB | 3678 | 260 | 1.7 (1.18, 2.44) | |
No CCBb | 4117 | 303 | 1.54 (0.98, 2.43) | 0.549 |
CCBb | 2240 | 247 | 1.35 (0.93, 1.98) | |
No Betablocker | 3811 | 309 | 1.51 (1.03, 2.22) | 0.411 |
Betablocker | 2546 | 241 | 1.4 (0.91, 2.16) | |
No Antihtn_otherc | 5252 | 411 | 1.41 (0.98, 2.01) | 0.649 |
Antihtn_otherc | 1105 | 139 | 1.55 (0.89, 2.69) | |
eGFR CKDEPI Categoriesa | ||||
≥ 120 | 135 | 5 | NA | 0.521 |
90–119 | 1617 | 47 | 1.6 (0.57, 4.47) | |
60–89 | 2677 | 215 | 1.34 (0.88, 2.04) | |
45–59 | 929 | 129 | 1.94 (1.17, 3.2) | |
30–44 | 417 | 76 | 1.08 (0.47, 2.47) | |
< 30 | 187 | 38 | 2.33 (0.32, 16.86) | |
CRP (mg/dL) | ||||
< 0.22 | 2546 | 220 | 1.18 (0.76, 1.84) | 0.582 |
0.22–0.99 | 2487 | 187 | 1.74 (1.16, 2.6) | |
≥ 1.00 | 981 | 109 | 2.17 (0.99, 4.77) | |
ACR | ||||
< 30 | 4807 | 310 | 1.79 (1.27, 2.52) | 0.063 |
30–300 | 1061 | 142 | 1.31 (0.83, 2.07) | |
≥ 300 | 292 | 57 | 0.93 (0.43, 2) |