title: Incidence and prognosis of resistant hypertension in hypertensive patients.
abstract: BACKGROUND
  Despite a recent American Heart Association (AHA) consensus statement emphasizing the importance of resistant hypertension, the incidence and prognosis of this condition are largely unknown.
  
  
  RESULTS
  This retrospective cohort study in 2 integrated health plans included patients with incident hypertension in whom treatment was begun between 2002 and 2006. Patients were followed up for the development of resistant hypertension based on AHA criteria of uncontrolled blood pressure despite use of ≥3 antihypertensive medications, with data collected on prescription filling information and blood pressure measurement. We determined incident cardiovascular events (death or incident myocardial infarction, heart failure, stroke, or chronic kidney disease) in patients with and without resistant hypertension with adjustment for patient and clinical characteristics. Among 205 750 patients with incident hypertension, 1.9% developed resistant hypertension within a median of 1.5 years from initial treatment (0.7 cases per 100 person-years of follow-up). These patients were more often men, were older, and had higher rates of diabetes mellitus than nonresistant patients. Over 3.8 years of median follow-up, cardiovascular event rates were significantly higher in those with resistant hypertension (unadjusted 18.0% versus 13.5%, P<0.001). After adjustment for patient and clinical characteristics, resistant hypertension was associated with a higher risk of cardiovascular events (hazard ratio, 1.47; 95% confidence interval, 1.33-1.62).
  
  
  CONCLUSIONS
  Among patients with incident hypertension in whom treatment was begun, 1 in 50 patients developed resistant hypertension. Patients with resistant hypertension had an increased risk of cardiovascular events, which supports the need for greater efforts toward improving hypertension outcomes in this population.
authors.affiliation: Division of Cardiology, University of Colorado-Denver, 12605 E 16th Ave., Aurora, CO 80045, USA. stacie.daugherty@ucdenver.edu
authors.forename: Stacie L
authors.initials: SL
authors.lastname: Daugherty
authors.forename: J David
authors.initials: JD
authors.lastname: Powers
authors.forename: David J
authors.initials: DJ
authors.lastname: Magid
authors.forename: Heather M
authors.initials: HM
authors.lastname: Tavel
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
authors.forename: Karen L
authors.initials: KL
authors.lastname: Margolis
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: O'Connor
authors.forename: Joe V
authors.initials: JV
authors.lastname: Selby
authors.forename: P Michael
authors.initials: PM
authors.lastname: Ho
mesh_terms: D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies