Stroke Is Associated with Refractory Hypertension among Resistant and Refractory Patients in a Cross-Sectional Study

Abstract Background Refractory hypertension (RfH) is a severe phenotype of resistant hypertension (RH) linked to higher risk of stroke and other adverse cardiovascular events, but knowledge about it is still lacking. Objectives To evaluate the association between RfH and stroke. Methods We conducted a cross-sectional study in a referral clinic for patients with severe hypertension in the period from 2018 to 2020. RH was defined as uncontrolled blood pressure (BP) despite the use of 3 antihypertensive agents, including a diuretic, or the use of ≥ 4 agents regardless of BP control. RfH was defined as lack of BP control despite use of ≥ 5 antihypertensive agents. Individuals were classified as RfH or RH, and multivariate logistic regression models were constructed to examine the association between RfH and stroke. Results We evaluated a total of 137 patients; 81% were female, and 93,3% were Black or multiracial. The mean age was 64.4 years. Stroke was more prevalent in the RfH group (35.7%), in comparison to the RH group (12.8%) (p value = 0.01). Unadjusted odds ratio (OR) and 95% confidence interval (CI) for factors associated with stroke were RfH (OR 3.77; 95% CI 1.45 to 9.80), systolic BP (OR 1.02; 95% CI 1.002 to 1.04) and diastolic BP (OR 1.03; 95% CI 1.001 to 1.06). Adjusted OR for factors associated with stroke were RfH (OR 3.55; 95% CI 1.02 to 12.42), systolic BP (OR 1.02; 95% CI 0.99 to 1.05) and diastolic BP (OR 1.01; 95% CI 0.96 to 1.06). Conclusion RfH was associated with higher prevalence of stroke. Efforts are required to better understand this association to prevent adverse cardiovascular outcomes in these patients.

【摘要】
背景：顽固性高血压（Refractory hypertension, RfH）是抵抗性高血压（Resistant hypertension, RH）的严重表型，与脑卒中及其他不良心血管事件的更高发病风险相关，但目前对其认知仍较为匮乏。
目的：评估顽固性高血压与脑卒中之间的关联。
方法：本研究于2018年至2020年期间，在一家重症高血压转诊门诊开展横断面研究。抵抗性高血压的定义为：尽管使用包括利尿剂在内的3种降压药物，血压仍未得到控制；或无论血压控制情况如何，均使用了≥4种降压药物。顽固性高血压的定义为：尽管使用了≥5种降压药物，血压仍未得到控制。研究对象被分为顽固性高血压组与抵抗性高血压组，随后构建多变量logistic回归模型，以探究二者间的关联。
结果：本研究共纳入137例患者，其中81%为女性，93.3%为黑人或多种族人群，平均年龄为64.4岁。顽固性高血压组的脑卒中患病率（35.7%）显著高于抵抗性高血压组（12.8%），差异具有统计学意义（P=0.01）。与脑卒中相关的未校正比值比（OR）及95%置信区间（CI）分别为：顽固性高血压（OR=3.77；95%CI：1.45~9.80）、收缩压（OR=1.02；95%CI：1.002~1.04）及舒张压（OR=1.03；95%CI：1.001~1.06）。校正后的相关因素比值比为：顽固性高血压（OR=3.55；95%CI：1.02~12.42）、收缩压（OR=1.02；95%CI：0.99~1.05）及舒张压（OR=1.01；95%CI：0.96~1.06）。
结论：顽固性高血压与更高的脑卒中患病率相关。未来需开展更多研究以明确二者间的关联机制，从而预防此类患者出现不良心血管结局。