Cardiovascular Prognosis in Drug-Resistant Hypertension Stratified by 24-Hour Ambulatory Blood Pressure: The JAMP Study
Kazuomi Kario, Satoshi Hoshide, Keisuke Narita, Yukie Okawara, Hiroshi Kanegae, Kenji Aoki, Hajime Kihara, Toshiro Koga, Tomoaki Nakata, Kenji Oku, Yasufumi Matsuoka, Hiroaki Omori, Masafumi Nishizawa, Yasuo Tanno, Yoko Fukase, Koki Omi, Jun Takahashi, Hiroyuki Mizuno, Michiya Saito, Junichi Yatabe, Kazuo Eguchi, Kiyoshi Iwashita, Maki Kumada, Gaku Oki, Gaku Oki, Tomoyuki Kabutoya, Kazuo Eguchi, Yukihiro Hojo, Masaru Ichida, Shizukiyo Ishikawa, Takahiro Komori, Yoshio Matsui, Masatoshi Matsumoto, Shoichiro Nagasaka, Masahiro Nakano, Yoshioki Nishimura, Kenta Okada, Kazuyuki Shimada, Masahisa Shimpo, Nozomu Takahashi, Hideyuki Uno, Joji Ishikawa, Shizukiyo Ishikawa, Kazuo Eguchi, Tomoyuki Kabutoya, Takahiro Komori, Toshio Kuroda, Nobutsune Hirahara, Yuta Kemi, Hisashi Yoshioka, Sakuo Hoshi, Atsuhi Mizuno, Kunihiko Ohno, Osamu Okazaki, Tsunehiro Saito, Tetsu Tanaka, Kazuo Yamashiro, Tatsuyuki Yamauchi, Shisei Yo, Shigeru Yomogita, Sayaka Hikita, Sakuo Hoshi, Yasuhiro Kawase, Yoshifumi Nojiri, Yukihiro Sato, Kiyoshi Uchiba, Motoyuki Ishiguro, Atsushi Taguchi, Kazumasa Iida, Tatsuya Takemoto, Katsuyuki Tone, Hideyasu Abe, Yasuhisa Abe, Masami Hasegawa, Tomohiro Katsuya, Yoshiharu Okada, Shinichiro Tanaka, Genyo Tanke, Takeshi Takami, Jun Michiura, Masahiko Shiotani, Tomohiro Aoki, Koichi Ogura, Yuzuru Kawamura, Shigekiyo Nakanishi, Nobuo Sasaki, Toshiyuki Takahashi, Akihisa Fujii, Eiichiro Tanaka, Hiroyuki Katayama, Yoshio Matsui, Yoshio Matsui, Motoki Fukutomi, Kosuke Miyoshi, Hiroaki Naito, Sawa Yokota, Kazumasa Nakamura, Tetsu Yokota, Shinsuke Takasugi, Shuichiro Fujita
Abstract
Resistant hypertension is an important cardiovascular risk factor. This analysis of the JAMP study (Japan Ambulatory Blood Pressure Monitoring Prospective) data investigated the effects of uncontrolled resistant hypertension diagnosed using ambulatory blood pressure (BP) monitoring on the risk of heart failure (HF) and overall cardiovascular events. The JAMP study patients with hypertension and no HF history were included. They had true resistant hypertension (24-hour BP ≥130/80 mm Hg), pseudoresistant hypertension (24-hour BP <130/80 mm Hg), well-controlled nonresistant hypertension (24-hour BP <130/80 mm Hg), or uncontrolled nonresistant hypertension (24-hour BP ≥130/80 mm Hg). The primary end point was total cardiovascular events, including atherosclerotic cardiovascular disease (fatal/nonfatal stroke and fatal/nonfatal coronary artery disease), and HF. During 4.5±2.4 years of follow-up the overall incidence per 1000 person-years was 10.1 for total cardiovascular disease, 4.1 for stroke, 3.5 for coronary artery disease, and 2.6 for HF. The adjusted risk of total cardiovascular and HF events was significantly increased in patients with true resistant versus controlled nonresistant hypertension (hazard ratio, 1.66 [95% CI, 1.12–2.48]; P =0.012 and 2.24 [95% CI, 1.17–4.30]; P =0.015, respectively) and versus uncontrolled nonresistant hypertension (1.51 [1.03–2.20]; P =0.034 and 3.03 [1.58–5.83]; P <0.001, respectively). The findings were robust in a sensitivity analysis using a slightly different definition of resistant hypertension. True resistant hypertension diagnosed using ambulatory BP monitoring is a significant independent risk factor for cardiovascular disease events, especially for HF. This highlights the importance of diagnosing and effectively treating resistant hypertension. Registration: URL: https://www.umin.ac.jp/ctr ; Unique identifier: UMIN000020377.