Supplemental Digital Content is available in the text. The prognostic importances of on-treatment clinic and ambulatory blood pressure (BP) levels have never been investigated in individuals with resistant hypertension. We aimed to evaluate them for the occurrence of incident cardiovascular and mortality outcomes in a prospective cohort of 1726 patients with resistant hypertension. Clinic and ambulatory BPs were measured at baseline and serially during follow-up (analyzed as time-varying and as mean cumulative BPs) and also categorized as controlled/uncontrolled as defined by the traditional and new 2017 American College of Cardiology/American Heart Association criteria. Multivariate Cox analyses examined the associations between BP parameters and the occurrence of total cardiovascular events, major adverse cardiovascular events, and cardiovascular and all-cause mortalities. C statistics and the integrated discrimination improvement indexes evaluated the improvement in risk discrimination. Over a median follow-up of 8.3 years, 417 total cardiovascular events occurred (358 major adverse cardiovascular events) and 391 individuals died (233 cardiovascular deaths). All single systolic BP (SBP) parameters significantly predicted all outcomes, but the associations were stronger for ambulatory SBPs than for clinic SBPs and for on-treatment SBPs (particularly for mean cumulative) than for baseline SBPs, and both improved risk discrimination (with increases in C statistic of up to 0.021 and integrated discrimination improvements of up to 19.7%). These findings were consistent for diastolic BPs. Uncontrolled ambulatory BPs were associated with higher risks for all outcomes, whereas uncontrolled clinic BPs were not. In conclusion, mean cumulative ambulatory BPs during follow-up were the best prognostic markers of adverse cardiovascular outcomes and mortality in patients with resistant hypertension. Serial ambulatory BP monitoring shall be more widely used in resistant hypertension management.

中文翻译：

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顽固性高血压中门诊和动态血压对预后的重要性

补充数字内容在文本中可用。从未在顽固性高血压患者中研究过治疗中诊所和动态血压 (BP) 水平对预后的重要性。我们旨在评估他们在 1726 名顽固性高血压患者的前瞻性队列中发生心血管事件和死亡率结果的情况。临床和动态血压在基线和随访期间连续测量（分析为时变和平均累积血压），并根据传统和新的 2017 年美国心脏病学会/美国心脏协会标准定义为受控/非受控. 多变量 Cox 分析检查了 BP 参数与总心血管事件、主要不良心血管事件、以及心血管和全因死亡率。C 统计量和综合歧视改善指数评估了风险歧视的改善。在 8.3 年的中位随访期间，总共发生了 417 起心血管事件（358 起主要不良心血管事件），391 人死亡（233 起心血管死亡）。所有单一收缩压 (SBP) 参数都显着预测了所有结果，但动态 SBP 的相关性强于诊所 SBP 和治疗中 SBP（特别是平均累积）比基线 SBP，并且两者都改善了风险识别（随着增加在 C 统计量高达 0.021 和高达 19.7% 的综合歧视改进）。这些发现与舒张压一致。不受控制的动态血压与所有结果的更高风险相关，而不受控制的诊所血压则不是。总之，随访期间的平均累积动态血压是顽固性高血压患者不良心血管结局和死亡率的最佳预后标志物。连续动态血压监测应在顽固性高血压管理中得到更广泛的应用。