title: Cardiovascular and mortality risk of apparent resistant hypertension in women with suspected myocardial ischemia: a report from the NHLBI-sponsored WISE Study.
abstract: BACKGROUND
  Women are more likely than men to develop resistant hypertension, which is associated with excess risk of major adverse outcomes; however, the impact of resistant hypertension in women with ischemia has not been explicitly studied. In this Women's Ischemia Syndrome Evaluation (WISE) analysis, we assessed long-term adverse outcomes associated with apparent treatment-resistant hypertension (aTRH) among women with suspected myocardial ischemia referred for coronary angiography.
  
  
  RESULTS
  Women (n=927) were grouped according to baseline blood pressure (BP): normotensive (no hypertension history, BP <140/90 mm Hg, no antihypertensive drugs); controlled (BP <140/90 mm Hg and a hypertension diagnosis or on 1 to 3 drugs); uncontrolled (BP ≥140/90 mm Hg on ≤2 drugs); or aTRH (BP ≥140/90 mm Hg on 3 drugs or anyone on ≥4 drugs). Adverse outcomes (first occurrence of death [any cause], nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure or angina) were collected over 10 years of follow-up. Apparent treatment-resistant hypertension prevalence was 10.4% among those with hypertension. Women with aTRH had a greater incidence of adverse outcomes, compared with normotensive women (adjusted hazard ratio [HR], 3.25; 95% confidence interval [CI], 1.94 to 5.43), and women with controlled (HR, 1.77; 95% CI, 1.26 to 2.49) and uncontrolled (HR, 1.62; 95% CI, 1.15 to 2.27) hypertension; outcome differences were evident early in follow-up. Risk of all-cause death was greater in the aTRH group, compared to the normotensive women and women with controlled and uncontrolled hypertension.
  
  
  CONCLUSIONS
  In this cohort of women with evidence of ischemia, aTRH was associated with a profoundly increased long-term risk of major adverse events, including death, that emerged early during follow-up.
authors.affiliation: Department of Pharmacotherapy & Translational Research, College of Pharmacy, University of Florida, Gainesville, FL.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Smith
authors.forename: Tianyao
authors.initials: T
authors.lastname: Huo
authors.forename: B
authors.initials: B
authors.lastname: Delia Johnson
authors.forename: Vera
authors.initials: V
authors.lastname: Bittner
authors.forename: Sheryl F
authors.initials: SF
authors.lastname: Kelsey
authors.forename: Diane
authors.initials: D
authors.lastname: Vido Thompson
authors.forename: C
authors.initials: C
authors.lastname: Noel Bairey Merz
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Pepine
authors.forename: Rhonda M
authors.initials: RM
authors.lastname: Cooper-Dehoff
mesh_terms: D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000453:epidemiology; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D017023:Coronary Angiography; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000401:mortality; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D054555:National Heart, Lung, and Blood Institute (U.S.); D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000959:Antihypertensive Agents
keywords: WISE; hypertension; resistant hypertension; women