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

Fingerprint

Type 2 Diabetes Mellitus
Cohort Studies
Prospective Studies
Hypertension
Mortality
Blood Pressure
Renal Insufficiency
Comorbidity
Kaplan-Meier Estimate
Masks
Pharmaceutical Preparations
Hypotension
Population
Multicenter Studies
Regression Analysis
Confidence Intervals

Keywords

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

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Is resistant hypertension an independent predictor of all-cause mortality in individuals with type 2 diabetes? A prospective cohort study. / Solini, Anna; Penno, Giuseppe; Orsi, Emanuela; Bonora, Enzo; Fondelli, Cecilia; Trevisan, Roberto; Vedovato, Monica; Cavalot, Franco; Lamacchia, Olga; Baroni, Marco Giorgio; Nicolucci, Antonio; Pugliese, Giuseppe; Bollanti, Lucilla; Alessi, Elena; Vitale, Martina; Cirrito, Tiziana; Cavallo-Perin, Paolo; Gruden, Gabriella; Lorenzati, Bartolomeo; Trovati, Mariella; Di Martino, Leonardo; Mazzaglia, Fabio; Zerbini, Giampaolo; Martina, Valentina; Maestroni, Silvia; Capuano, Valentina; Palmieri, Eva; Lunati, Elena; Grancini, Valeria; Resi, Veronica; Pontiroli, Antonio; Veronelli, Annamaria; Zecchini, Barbara; Arosio, Maura; Montefusco, Laura; Rossi, Antonio; Adda, Guido; Corsi, Anna; Albizzi, Mascia; Zoppini, Giacomo; Avogaro, Angelo; Pucci, Laura; Lucchesi, Daniela; Russo, Eleonora; Garofolo, Monia; Dotta, Francesco; Nigi, Laura; Morano, Susanna; Filardi, Tiziana; Turinese, Irene.

In: BMC Medicine, Vol. 17, No. 1, 83, 25.04.2019.

Research output: Contribution to journalReview article

Solini, A, Penno, G, Orsi, E, Bonora, E, Fondelli, C, Trevisan, R, Vedovato, M, Cavalot, F, Lamacchia, O, Baroni, MG, Nicolucci, A, Pugliese, G, Bollanti, L, Alessi, E, Vitale, M, Cirrito, T, Cavallo-Perin, P, Gruden, G, Lorenzati, B, Trovati, M, Di Martino, L, Mazzaglia, F, Zerbini, G, Martina, V, Maestroni, S, Capuano, V, Palmieri, E, Lunati, E, Grancini, V, Resi, V, Pontiroli, A, Veronelli, A, Zecchini, B, Arosio, M, Montefusco, L, Rossi, A, Adda, G, Corsi, A, Albizzi, M, Zoppini, G, Avogaro, A, Pucci, L, Lucchesi, D, Russo, E, Garofolo, M, Dotta, F, Nigi, L, Morano, S, Filardi, T & 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, vol. 17, no. 1, 83. https://doi.org/10.1186/s12916-019-1313-x
Solini, Anna ; Penno, Giuseppe ; Orsi, Emanuela ; Bonora, Enzo ; Fondelli, Cecilia ; Trevisan, Roberto ; Vedovato, Monica ; Cavalot, Franco ; Lamacchia, Olga ; Baroni, Marco Giorgio ; Nicolucci, Antonio ; Pugliese, Giuseppe ; Bollanti, Lucilla ; Alessi, Elena ; Vitale, Martina ; Cirrito, Tiziana ; Cavallo-Perin, Paolo ; Gruden, Gabriella ; Lorenzati, Bartolomeo ; Trovati, Mariella ; Di Martino, Leonardo ; Mazzaglia, Fabio ; Zerbini, Giampaolo ; Martina, Valentina ; Maestroni, Silvia ; Capuano, Valentina ; Palmieri, Eva ; Lunati, Elena ; Grancini, Valeria ; Resi, Veronica ; Pontiroli, Antonio ; Veronelli, Annamaria ; Zecchini, Barbara ; Arosio, Maura ; Montefusco, Laura ; Rossi, Antonio ; Adda, Guido ; Corsi, Anna ; Albizzi, Mascia ; Zoppini, Giacomo ; Avogaro, Angelo ; Pucci, Laura ; Lucchesi, Daniela ; Russo, Eleonora ; Garofolo, Monia ; Dotta, Francesco ; Nigi, Laura ; Morano, Susanna ; Filardi, Tiziana ; Turinese, Irene. / Is resistant hypertension an independent predictor of all-cause mortality in individuals with type 2 diabetes? A prospective cohort study. In: BMC Medicine. 2019 ; Vol. 17, No. 1.
@article{faf19b897228403c8050a203cbf87e4c,
title = "Is resistant hypertension an independent predictor of all-cause mortality in individuals with type 2 diabetes? A prospective cohort study",
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.",
keywords = "All-cause mortality, Cardiovascular disease, Chronic kidney disease, Resistant hypertension, Type 2 diabetes",
author = "Anna Solini and Giuseppe Penno and Emanuela Orsi and Enzo Bonora and Cecilia Fondelli and Roberto Trevisan and Monica Vedovato and Franco Cavalot and Olga Lamacchia and Baroni, {Marco Giorgio} and Antonio Nicolucci and Giuseppe Pugliese and Lucilla Bollanti and Elena Alessi and Martina Vitale and Tiziana Cirrito and Paolo Cavallo-Perin and Gabriella Gruden and Bartolomeo Lorenzati and Mariella Trovati and {Di Martino}, Leonardo and Fabio Mazzaglia and Giampaolo Zerbini and Valentina Martina and Silvia Maestroni and Valentina Capuano and Eva Palmieri and Elena Lunati and Valeria Grancini and Veronica Resi and Antonio Pontiroli and Annamaria Veronelli and Barbara Zecchini and Maura Arosio and Laura Montefusco and Antonio Rossi and Guido Adda and Anna Corsi and Mascia Albizzi and Giacomo Zoppini and Angelo Avogaro and Laura Pucci and Daniela Lucchesi and Eleonora Russo and Monia Garofolo and Francesco Dotta and Laura Nigi and Susanna Morano and Tiziana Filardi and Irene Turinese",
year = "2019",
month = "4",
day = "25",
doi = "10.1186/s12916-019-1313-x",
language = "English",
volume = "17",
journal = "BMC Medicine",
issn = "1741-7015",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Is resistant hypertension an independent predictor of all-cause mortality in individuals with type 2 diabetes? A prospective cohort study

AU - Solini, Anna

AU - Penno, Giuseppe

AU - Orsi, Emanuela

AU - Bonora, Enzo

AU - Fondelli, Cecilia

AU - Trevisan, Roberto

AU - Vedovato, Monica

AU - Cavalot, Franco

AU - Lamacchia, Olga

AU - Baroni, Marco Giorgio

AU - Nicolucci, Antonio

AU - Pugliese, Giuseppe

AU - Bollanti, Lucilla

AU - Alessi, Elena

AU - Vitale, Martina

AU - Cirrito, Tiziana

AU - Cavallo-Perin, Paolo

AU - Gruden, Gabriella

AU - Lorenzati, Bartolomeo

AU - Trovati, Mariella

AU - Di Martino, Leonardo

AU - Mazzaglia, Fabio

AU - Zerbini, Giampaolo

AU - Martina, Valentina

AU - Maestroni, Silvia

AU - Capuano, Valentina

AU - Palmieri, Eva

AU - Lunati, Elena

AU - Grancini, Valeria

AU - Resi, Veronica

AU - Pontiroli, Antonio

AU - Veronelli, Annamaria

AU - Zecchini, Barbara

AU - Arosio, Maura

AU - Montefusco, Laura

AU - Rossi, Antonio

AU - Adda, Guido

AU - Corsi, Anna

AU - Albizzi, Mascia

AU - Zoppini, Giacomo

AU - Avogaro, Angelo

AU - Pucci, Laura

AU - Lucchesi, Daniela

AU - Russo, Eleonora

AU - Garofolo, Monia

AU - Dotta, Francesco

AU - Nigi, Laura

AU - Morano, Susanna

AU - Filardi, Tiziana

AU - Turinese, Irene

PY - 2019/4/25

Y1 - 2019/4/25

N2 - 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.

AB - 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.

KW - All-cause mortality

KW - Cardiovascular disease

KW - Chronic kidney disease

KW - Resistant hypertension

KW - Type 2 diabetes

UR - http://www.scopus.com/inward/record.url?scp=85065320995&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85065320995&partnerID=8YFLogxK

U2 - 10.1186/s12916-019-1313-x

DO - 10.1186/s12916-019-1313-x

M3 - Review article

C2 - 31023377

AN - SCOPUS:85065320995

VL - 17

JO - BMC Medicine

JF - BMC Medicine

SN - 1741-7015

IS - 1

M1 - 83

ER -