CARDIOVASCULAR AND KIDNEY OUTCOMES IN TREATED RESISTANT HYPERTENSIVE PATIENTS.

OBJECTIVE: To evaluate the incidence of cardiovascular (CV) and kidney outcomes and its predictors in treated resistant hypertensive (rHTN) patients.

DESIGN AND METHOD: We studied 117 rHTN patients and 114 controlled hypertensives (cHTN) patients on a triple fixed-dose combination of RAAS blockers / CCB / thiazide or thiazide-like diuretic. Patients with rHTN treated with the same type of triple fixed-dose combination in maximally tolerated doses plus the individually defined most effective fourth-line agent (spironolactone/eplerenone 56.1%, torasemide 26.8%, nebivolol 14.6%, moxonidine 2.5%); the fifth class of antihypertensive drug was added for 35.2 % of patients. A composite CV (CV death, myocardial infarction and/or revascularization, stroke, atrial fibrillation, and peripheral arterial disease) and kidney outcome (dialysis or GFR decline by 40% or greater) were estimated after five years (a mean follow-up 5.1 ± 0.1). The combined endpoint was defined as total CV and renal outcome events.

RESULTS: The goal office and 24-h BP were achieved at 49.6 and 34.2 % rHTN patients by the end of 5-year follow-up. During follow-up the incidence of all outcomes were higher at rHTN patients compared to cHTN pts: composite CV events (26.5 % vs 7 %, P = 0.001), kidney outcomes (4.3 % vs 0.9 %, P = 0.01), and diabetes (3.4 % vs 0.9 %, P = 0.02). The independent predictors of combined end point identified by multivariant logistic regression analysis were initial 24-h systolic BP ( = 0.099; OR = 1.10; 95 % CI 1.03 - 1.18; P = 0.008), blood concentration of endothelial progenitor cells (CD45+/CD34+) ( = - 0.89; OR = 0.41; 95 % CI: 0.21 - 0.79), P = 0.007) and citrulline ( = - 0.89; OR = 1.13; 95 % CI: 1.07 - 1.20; P < 0.001).

CONCLUSIONS: Despite significant improvement in BP control the incidence of CV and renal outcomes in rHTN patients were higher than in cHTN patients. The independent predictors of combined CV and renal events were higher baseline systolic blood pressure, citrulline plasma level, and low concentration of endothelial progenitor cells.