Resistant Hypertension and Susceptible Outcomes: Exploring the Benefits of Aggressive Blood Pressure Control

Smith, Steven M.

doi:10.1111/jch.12677

Cited by 3 publications

(3 citation statements)

References 19 publications

(29 reference statements)

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“…Additional research also is needed to determine the impact of this intervention, and others, on hard outcomes beyond BP-lowering in persons with TRH. 41 Nevertheless, our results add further empirical evidence to the use of such models in hypertension treatment generally, and extend these previous findings to those with TRH. …”

Section: Resultssupporting

confidence: 84%

Physician-pharmacist collaboration versus usual care for treatment-resistant hypertension

Smith

Carris

Dietrich

et al. 2016

Journal of the American Society of Hypertension

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Team-based care has been recommended for patients with treatment-resistant hypertension (TRH), but its efficacy in this setting is unknown. We compared a physician-pharmacist collaborative model (PPCM) to usual care in patients with TRH participating in the Collaboration Among Pharmacists and physicians To Improve Outcomes Now (CAPTION) study. At baseline, 169 patients (27% of CAPTION patients) had TRH: 111 received the PPCM intervention and 58 received usual care. Baseline characteristics were similar between treatment arms. After 9 months, adjusted mean systolic BP was reduced by 7 mmHg more with PPCM intervention than usual care (p=0.036). BP control was 34.2% with PPCM versus 25.9% with usual care (adjusted OR, 1.92; 95% CI, 0.33–11.2). These findings suggest that team-based care in the primary care setting may be effective for TRH. Additional research is needed regarding the long-term impact of these models and to identify patients most likely to benefit from team-based interventions.

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Section: Resultssupporting

confidence: 84%

Physician-pharmacist collaboration versus usual care for treatment-resistant hypertension

Smith

Carris

Dietrich

et al. 2016

Journal of the American Society of Hypertension

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“…This is most likely because we are treating a population with a higher risk. However, we cannot discount the significance of controlling BP, since it reduces the absolute CV risk and delays or even prevents the development of organ lesions, such as CKD, which further increase the CV risk in such patients [37]. Contrary to previous research [31,33], a greater number of cerebrovascular events were observed in the present study than acute myocardial infarction.…”

Section: Discussioncontrasting

confidence: 90%

Systolic Blood Pressure and Pulse Pressure Are Predictors of Future Cardiovascular Events in Patients with True Resistant Hypertension

et al. 2023

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Given the increased risk of cardiovascular events associated with resistant hypertension, predictive cardiovascular prognosis is extremely important. Ambulatory blood pressure monitoring (ABPM) is mandatory for resistant hypertension diagnosis, but its use for prognosis is scarce. This observational longitudinal study included 258 patients (mean age of 60.4 ± 11.2 years; 61.2% male), who underwent 24 h ABPM in a hypertension unit from 1999 to 2019. The outcomes were global cardiovascular events (cerebrovascular, coronary, and other cardiovascular events). The mean follow-up period was 6.0 ± 5.0 years. Sixty-eight cardiovascular events (61 nonfatal) were recorded. Patients who experienced cardiovascular events were generally older, with higher rates of chronic kidney disease and prior cardiovascular events. The 24 h systolic blood pressure (hazard ratio 1.44; 95% CI 1.10–1.88), night systolic blood pressure (1.35; 95% CI 1.01–1.80), and 24 h pulse pressure (2.07; 95% CI 1.17–3.67) were independent predictors of global cardiovascular events. Multivariate Cox analysis revealed a higher risk of future cardiovascular events, particularly in patients with a 24 h daytime and nighttime pulse pressure > 60 mm Hg with respective hazard ratios of 1.95; 95% CI 1.01–3.45; 2.15; 95% CI 1.21–3.83 and 2.07; 95% CI 1.17–3.67. In conclusion, APBM is a fundamental tool not only for the diagnosis of resistant hypertension, but also for predicting future cardiovascular events.

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“…36 Patients with RH typically have many comorbidities that increase cardiovascular risk, and it is at least plausible that fairly minor reductions in BP, such as that seen in PATH-WAY-2 (ie, 4.5 mm Hg) have limited impact on reducing risk for cardiovascular events in the setting of so many competing risk factors. 37 Unfortunately, we were not able to examine differences in BP response during follow-up, and it is therefore possible that the lack of difference observed in cardiovascular events is merely reflective of minimal or no differences in BP response between comparators in our population. On the other hand, given the point estimate and confidence interval observed in our main analysis (aHR, 0.77 [95% CI, 0.50-1.19]), we cannot exclude the possibility that aldosterone antagonists do in fact reduce risk of cardiovascular events, but which our study was underpowered to detect.…”

Section: Discussionmentioning

confidence: 93%

Comparative Safety and Effectiveness of Aldosterone Antagonists Versus Beta-Blockers as Fourth Agents in Patients With Apparent Resistant Hypertension

Desai¹,

Park²,

Brown³

et al. 2022

Hypertension

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BACKGROUND: Limited evidence exists regarding long-term effectiveness and safety of aldosterone antagonists (AAs) versus beta blockers (BBs) as fourth-line antihypertensive agents in patients with resistant hypertension (RH). We evaluated the comparative effectiveness and safety of aldosterone AA versus BB. METHODS: We conducted a real-world retrospective cohort study using IBM MarketScan commercial claims and Medicare Supplemental claims (2007–2019). Patients with RH entered the cohort (ie, index date) when they newly initiated either AA or BB. The effectiveness outcome was major adverse cardiovascular events. Safety outcomes were hyperkalemia, gynecomastia, and kidney function deterioration. Potential confounding was addressed by adjustment for baseline characteristics via stabilized inverse probability of treatment weighting (SIPTW) based on propensity scores. Cox proportional hazards regression with SIPTWs were used to estimate adjusted hazard ratio (aHR) and 95% CI comparing risk for outcomes between AA and BB groups. RESULTS: We identified 80 598 patients with RH (mean age: 61 years, 51% males), of which 6626 initiated AA and 73 972 initiated BB as the fourth antihypertensive agent. Among patients with RH, initiation of AA as a fourth-line antihypertensive agent did not significantly reduce major adverse cardiovascular event risk relative to BB initiation (aHR, 0.77 [95% CI, 0.50–1.19]) but did substantially increase the risk of hyperkalemia (aHR, 3.86 [95% CI, 2.78–5.34]), gynecomastia (aHR, 9.51 [95% CI, 5.69–15.89]), and kidney function deterioration (aHR, 1.63 [95% CI, 1.34–1.99]). CONCLUSIONS: Long-term clinical trials powered to assess major adverse cardiovascular events are necessary to understand the risk-benefit trade-off of AA as fourth-line therapy for RH.

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Resistant Hypertension and Susceptible Outcomes: Exploring the Benefits of Aggressive Blood Pressure Control

Cited by 3 publications

References 19 publications

Physician-pharmacist collaboration versus usual care for treatment-resistant hypertension

Physician-pharmacist collaboration versus usual care for treatment-resistant hypertension

Systolic Blood Pressure and Pulse Pressure Are Predictors of Future Cardiovascular Events in Patients with True Resistant Hypertension

Comparative Safety and Effectiveness of Aldosterone Antagonists Versus Beta-Blockers as Fourth Agents in Patients With Apparent Resistant Hypertension

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