title: Mortality Risk Associated With Resistant Hypertension Among Women: Analysis from Three Prospective Cohorts Encompassing the Spectrum of Women's Heart Disease.
abstract: BACKGROUND
  Women are at greater risk of developing resistant hypertension (RH) than men, yet scarce data exist on RH-associated outcomes in women. We aimed to determine all-cause mortality risk associated with apparent RH (aRH) among women across the spectrum of underlying coronary disease.
  
  
  METHODS
  We analyzed data from St. James Women Take Heart (WTH; women without coronary disease at baseline), Women's Ischemia Syndrome Evaluation (women with signs/symptoms of ischemia at baseline), and the INternational VErapamil-Trandolapril STudy (INVEST; women with coronary artery disease and hypertension at baseline), totaling 15,108 adult women with no hypertension, non-RH (blood pressure [BP] ≥140/90 mmHg on ≤2 drugs or BP <140/90 mmHg on 1-3 drugs), or aRH (BP ≥140/90 mmHg on ≥3 drugs or anyone on ≥4 drugs) at baseline. The primary outcome was all-cause mortality.
  
  
  RESULTS
  Prevalence of aRH ranged from 0.4% (WTH) to 10.6% (INVEST). Women with aRH, compared to those without, were older, more often black, and more likely to be obese or diabetic. Pooling all cohorts, risk for all-cause death was greater in women with aRH than in women with non-RH (adjusted HR 1.40; 95% CI 1.27-1.55) and women without hypertension (adjusted HR 2.34; 95% CI 1.76-3.11) over a median follow-up of 14.3 years.
  
  
  CONCLUSIONS
  aRH prevalence in women varies according to underlying coronary disease, and aRH is associated with a substantial, early, and sustained increased risk of all-cause death. Additional research into early recognition and prevention strategies for RH are needed, especially in black and older women, and those with known cardiovascular risk factors.
authors.affiliation: 1 Department of Pharmacotherapy & Translational Research, College of Pharmacy, University of Florida , Gainesville, Florida.|2 Department of Community Health & Family Medicine, College of Medicine, University of Florida , Gainesville, Florida.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Smith
authors.affiliation: 3 Division of Cardiology, Department of Medicine, College of Medicine, University of Florida , Gainesville, Florida.
authors.forename: Tianyao
authors.initials: T
authors.lastname: Huo
authors.affiliation: 1 Department of Pharmacotherapy & Translational Research, College of Pharmacy, University of Florida , Gainesville, Florida.
authors.forename: Yan
authors.initials: Y
authors.lastname: Gong
authors.affiliation: 3 Division of Cardiology, Department of Medicine, College of Medicine, University of Florida , Gainesville, Florida.
authors.forename: Eileen
authors.initials: E
authors.lastname: Handberg
authors.affiliation: 4 Division of Cardiology, University of Arizona College of Medicine-Phoenix , Phoenix, Arizona.
authors.forename: Martha
authors.initials: M
authors.lastname: Gulati
authors.affiliation: 5 Barbara Streisand Women's Heart Center, Cedars-Sinai Heart Institute , Los Angeles, California.
authors.forename: C Noel Bairey
authors.initials: CN
authors.lastname: Merz
authors.affiliation: 3 Division of Cardiology, Department of Medicine, College of Medicine, University of Florida , Gainesville, Florida.
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Pepine
authors.affiliation: 1 Department of Pharmacotherapy & Translational Research, College of Pharmacy, University of Florida , Gainesville, Florida.|3 Division of Cardiology, Department of Medicine, College of Medicine, University of Florida , Gainesville, Florida.
authors.forename: Rhonda M
authors.initials: RM
authors.lastname: Cooper-DeHoff
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D003324:Coronary Artery Disease / Q000150:complications; D004351:Drug Resistance; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000401:mortality*; D007211:Indoles / Q000627:therapeutic use*; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications; D009765:Obesity / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014700:Verapamil / Q000627:therapeutic use*
chemical_list: D000959:Antihypertensive Agents; D007211:Indoles; C052035:trandolapril; D014700:Verapamil
keywords: INVEST; WISE; hypertension; mortality; resistant hypertension; women