OBJECTIVE To evaluate the prognostic importance of resistant hypertension (RHT) for the development of complications in a cohort of individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS A total of 646 patients had the diagnosis of apparent treatment-resistant hypertension (aRHT) based on mean office blood pressure (BP) levels during the 1st year of follow-up. They were reclassified as white-coat/controlled or true/uncontrolled RHT according to 24-h ambulatory BP monitoring (ABPM), using the traditional BP cutoffs and the new 2017 American College of Cardiology (ACC)/American Heart Association (AHA) criteria. Multivariate Cox analyses examined the associations between RHT diagnoses and the occurrence of microvascular and cardiovascular complications and all-cause and cardiovascular mortality. RESULTS During a median follow-up of 10 years, 177 patients had a cardiovascular event (145 major ones); 222 patients died (101 from cardiovascular diseases); 200 had a renal event; 156 had a retinopathy event; and 174 patients had a neuropathy event. In relation to non-RHT individuals, aRHT (present in 44.6% and 50% by the traditional and new criteria, respectively) predicted all cardiovascular and mortality outcomes, with hazard ratios (HRs) between 1.64 and 2.16, but none of the microvascular outcomes. True RHT increased the HRs (from 1.81 to 2.25) and additionally predicted renal outcomes. White-coat/controlled RHT implied an increased risk (HRs 1.33-1.86) that was intermediate between non-RHT and true RHT individuals. Classifications using the traditional and the new ACC/AHA criteria were equivalent. CONCLUSIONS In patients with type 2 diabetes, the presence of aRHT implied an increased risk of cardiovascular and mortality outcomes, and classification based on ABPM predicted renal outcomes and improved cardiovascular/mortality risk stratification.

中文翻译：

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2型糖尿病患者抵抗性高血压的预后重要性：里约热内卢2型糖尿病队列研究。

目的评估抵抗性高血压（RHT）对一组2型糖尿病患者并发症发展的预后重要性。研究设计和方法根据随访第一年的平均办公室血压（BP）水平，总共646例患者被诊断为明显的抗治疗性高血压（aRHT）。根据传统的BP临界值和新的2017年美国心脏病学会（ACC）/美国心脏协会（AHA）标准，根据24小时动态BP监测（ABPM），将它们重新分类为白大衣/对照或真实/不受对照的RHT 。多变量Cox分析检查了RHT诊断与微血管和心血管并发症的发生以及全因和心血管死亡率之间的关联。结果在平均10年的随访中，177名患者发生了心血管事件（145名重大事件）；222例患者死亡（101例心血管疾病）；200名患者有肾脏事件；156例发生视网膜病变；174名患者发生了神经病。对于非RHT个体，aRHT（分别按传统和新标准分别占44.6％和50％）预测了所有心血管和死亡率结局，危险比（HRs）在1.64和2.16之间，但没有微血管结局。真正的RHT可以增加HR（从1.81到2.25），并可以预测肾结局。白大衣/对照RHT意味着风险增加（HR 1.33-1.86），介于非RHT和真实RHT个人之间。使用传统和新的ACC / AHA标准进行分类是等效的。结论在2型糖尿病患者中，