Resistant hypertension (RH) has been poorly studied due to the difficulty in distinguishing it from nonadherence—the exclusion of which is necessary to accurately diagnose RH. Therefore, little is known about the prevalence, predictors, and outcomes of true RH. We evaluated 1838 patients from the standard blood pressure (BP) arm of the Action to Control Cardiovascular Risk in Diabetes Trial. We classified patients into three groups: “true RH”, “pseudo-RH” (i.e., patients with BP levels that would classify them as RH but who were non-adherent), and “other” (i.e., those who could not be classified as having “true RH” or “pseudo-RH”). We examined predictors of true and pseudo-RH and the relationship between true RH and the composite outcome of nonfatal MI, nonfatal stroke, or cardiovascular death. Among 1838 participants with complete information, 489 (26.6%) met the definition of true RH, and 94 (16.1%) RH patients had “pseudo-RH” on ≥1 visit over the first 12 months. Predictors of RH included: baseline SBP ≥ 160 mmHg (OR = 8.79; 95% CI: 5.70–13.68) and baseline SBP between 140–159 (OR = 2.91; 95% CI: 2.13–4.00) compared to SBP < 140, additional baseline BP medication (OR = 3.40; 95% CI: 2.83–4.11), macroalbuminuria (OR = 2.35; 95% CI: 1.50–3.67), CKD (OR = 1.53; 95% CI: 0.99–2.33), history of stroke (OR = 1.73; 95% CI: 1.04–2.82), and black race (OR = 1.39; 95% CI: 1.02–1.88); the cross-validated C-statistic was 0.80. “True RH” patients had a 65% increased hazard in composite outcome (HR = 1.65; 95% CI: 1.13–2.42). In conclusion, the majority of patients classified as having RH had “true RH,” which was more common among those who are black, have macroalbuminuria, CKD, stroke, higher baseline SBP, and are taking more baseline antihypertensives. These patients are at increased risk for cardiovascular and mortality events.

由于难以将其与不依从性区分开来，因此对顽固性高血压 (RH) 的研究很少——排除后者对于准确诊断 RH 是必要的。因此，人们对真正 RH 的患病率、预测因素和结果知之甚少。我们评估了糖尿病试验中控制心血管风险行动的标准血压 (BP) 组的 1838 名患者。我们将患者分为三组：“真 RH”、“假 RH”（即，BP 水平可将其归类为 RH 但不依从性的患者）和“其他”（即，不能归类为具有“真正的 RH”或“伪 RH”）。我们检查了真和假 RH 的预测因子，以及真 RH 与非致死性 MI、非致死性卒中或心血管死亡的复合结局之间的关系。在信息完整的1838名参与者中，489 名 (26.6%) 符合真正 RH 的定义，94 名 (16.1%) RH 患者在前 12 个月内≥1 次就诊时出现“假性 RH”。RH 的预测因子包括：基线 SBP ≥ 160 mmHg（OR = 8.79；95% CI：5.70-13.68）和基线 SBP 在 140-159（OR = 2.91；95% CI：2.13-4.00）与 SBP < 140 相比，额外基线血压药物（OR = 3.40；95% CI：2.83-4.11），大量白蛋白尿（OR = 2.35；95% CI：1.50-3.67），CKD（OR = 1.53；95% CI：0.99-2.33），卒中史（OR = 1.73；95% CI：1.04–2.82）和黑人（OR = 1.39；95% CI：1.02–1.88）；交叉验证的 C 统计量为 0.80。“真正的 RH”患者在复合结局中的风险增加了 65%（HR = 1.65；95% CI：1.13-2.42）。总之，大多数被归类为 RH 的患者患有“真正的 RH”，这在黑人、大量白蛋白尿、CKD、中风、更高的基线 SBP，并且正在服用更多的基线降压药。这些患者发生心血管和死亡事件的风险增加。