Objective:Little is known regarding the clinical course and prognosis of
resistant hypertension (RHT). We evaluated predictors of persistent RHT
and the associated cardiovascular risk.Methods:We studied 1911 treated
hypertensive patients (aged 5911 years, 49% men) for a mean period of
3.9 years. At baseline, clinical data were collected and patients
underwent echocardiographic measurements, routine blood testing and
additional workup for exclusion of secondary causes of RHT (office-based
uncontrolled hypertension under at least three drugs including a
diuretic or controlled hypertension under four or more drugs). Endpoint
of interest was the composite of coronary artery disease and stroke.Main
results:Four groups were identified depending on presence or absence of
RHT at baseline and follow-up: 1153 patients (60%) never having RHT,
189 (10%) with resolved RHT, 204 (11%) with incident RHT and 365
(19%) with persistent RHT. Two-thirds of the patients with RHT at
baseline remained resistant at the end of the study. Independent
variables associated with both incident and persistent RHT were diabetes
mellitus, history of cardiovascular disease, hypertension duration, SBP,
left ventricular hypertrophy and glomerular filtration rate. Persistent
RHT compared with never-having RHT was associated with a 2.2-fold
increased risk for cardiovascular morbidity (95% CI: 1.21-4.05, P=0.01)
after adjustment for risk factors.Conclusion:In treated hypertensive
patients, among prospective RHT dynamic patterns, persistent RHT is
frequent and independently associated with adverse cardiovascular
prognosis