Is resistant hypertension an independent predictor of all-cause mortality in individuals with type 2 diabetes? A prospective cohort study

Anna Solini, Giuseppe Penno, Emanuela Orsi, Enzo Bonora, Cecilia Fondelli, Roberto Trevisan, Monica Vedovato, Franco Cavalot, Olga Lamacchia, Marco Giorgio Baroni, Antonio Nicolucci, Giuseppe Pugliese, Lucilla Bollanti, Elena Alessi, Martina Vitale, Tiziana Cirrito, Paolo Cavallo-Perin, Gabriella Gruden, Bartolomeo Lorenzati, Mariella TrovatiLeonardo Di Martino, Fabio Mazzaglia, Giampaolo Zerbini, Valentina Martina, Silvia Maestroni, Valentina Capuano, Eva Palmieri, Elena Lunati, Valeria Grancini, Veronica Resi, Antonio Pontiroli, Annamaria Veronelli, Barbara Zecchini, Maura Arosio, Laura Montefusco, Antonio Rossi, Guido Adda, Anna Corsi, Mascia Albizzi, Giacomo Zoppini, Angelo Avogaro, Laura Pucci, Daniela Lucchesi, Eleonora Russo, Monia Garofolo, Francesco Dotta, Laura Nigi, Susanna Morano, Tiziana Filardi, Irene Turinese

Research output: Contribution to journalReview article

Abstract

Background: Resistant hypertension is independently associated with an increased risk of death in the general hypertensive population. We assessed whether resistant hypertension is an independent predictor of all-cause mortality in individuals with type 2 diabetes from the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicentre Study. Methods: On 31 October 2015, vital status information was retrieved for 15,656 of the 15,773 participants enrolled in 2006-2008. Based on baseline blood pressure (BP) values and treatment, participants were categorized as normotensive, untreated hypertensive, controlled hypertensive (i.e., on-target with < 3 drugs), uncontrolled hypertensive (i.e., not on-target with 1-2 drugs), or resistant hypertensive (i.e., uncontrolled with > 3 drugs or controlled with > 4 drugs). Kaplan-Meier and Cox proportional hazards regression analyses were used to assess the association with all-cause mortality. Results: Using the 130/80 mmHg targets for categorization, crude mortality rates and Kaplan-Meier estimates were highest among resistant hypertension participants, especially those with controlled resistant hypertension. As compared with resistant hypertension, risk for all-cause mortality was significantly lower for all the other groups, including individuals with controlled hypertension (hazard ratio 0.81 [95% confidence interval 0.74-0.89], P < 0.0001), but became progressively similar between resistant and controlled hypertension after adjustment for cardiovascular risk factors and complications/comorbidities. Also when compared with controlled resistant hypertension, mortality risk was significantly lower for all the other groups, including controlled hypertension, even after adjusting for cardiovascular risk factors (0.77 [0.63-0.95], P = 0.012), but not for complications/comorbidities (0.88 [0.72-1.08], P = 0.216). BP was well below target in the controlled hypertensive groups (resistant and non-resistant) and values < 120/70 mmHg were associated with an increased mortality risk. Results changed only partly when using the 140/90 mmHg targets for categorization. Conclusions: In the RIACE cohort, at variance with the general hypertensive population, resistant hypertension did not predict death beyond target organ damage. Our findings may be explained by the high mortality risk conferred by type 2 diabetes and the low BP values observed in controlled hypertensive patients, which may mask risk associated with resistant hypertension. Less stringent BP goals may be preferable in high-risk patients with type 2 diabetes.

Original languageEnglish
Article number83
JournalBMC Medicine
Volume17
Issue number1
DOIs
Publication statusPublished - Apr 25 2019

Keywords

  • All-cause mortality
  • Cardiovascular disease
  • Chronic kidney disease
  • Resistant hypertension
  • Type 2 diabetes

ASJC Scopus subject areas

  • Medicine(all)

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    Solini, A., Penno, G., Orsi, E., Bonora, E., Fondelli, C., Trevisan, R., Vedovato, M., Cavalot, F., Lamacchia, O., Baroni, M. G., Nicolucci, A., Pugliese, G., Bollanti, L., Alessi, E., Vitale, M., Cirrito, T., Cavallo-Perin, P., Gruden, G., Lorenzati, B., ... Turinese, I. (2019). Is resistant hypertension an independent predictor of all-cause mortality in individuals with type 2 diabetes? A prospective cohort study. BMC Medicine, 17(1), [83]. https://doi.org/10.1186/s12916-019-1313-x