Stroke Is Associated with Refractory Hypertension among Resistant and Refractory Patients in a Cross-Sectional Study

Author(s)

Guilherme de Andrade Costa ^[1] ; Jamary Oliveira Filho ^[2] ; Luana Ferreira-Campos ^[3] ; Alex Cleber Improta-Caria ; Cristiano Macedo ^[5] ; Marcelo Vincenzo Sarno Filho ^[6] ; Leonardo Silva Roever Borges ^[7] ; Roque Aras Júnior ^[8]

Affiliation

^[1] Universidade Federal da Bahia - Brasil

^[2] Universidade Federal da Bahia - Brasil

^[3] Universidade Federal da Bahia - Brasil

^[5] Hospital Universitário Professor Edgard Santos - Brasil

^[6] Universidade Federal da Bahia - Brasil

^[7] Universidade Federal de Uberlândia - Brasil

^[8] Universidade Federal da Bahia - Brasil

• Document type: Journal article
• Source: International Journal of Cardiovascular Sciences; v. 36, 2023-07-10.

Abstract

Abstract Background Refractory hypertension (RfH) is a severe phenotype of resistant hypertension (RH) linked to higher risk of stroke and other adverse cardiovascular events, but knowledge about it is still lacking. Objectives To evaluate the association between RfH and stroke. Methods We conducted a cross-sectional study in a referral clinic for patients with severe hypertension in the period from 2018 to 2020. RH was defined as uncontrolled blood pressure (BP) despite the use of 3 antihypertensive agents, including a diuretic, or the use of ≥ 4 agents regardless of BP control. RfH was defined as lack of BP control despite use of ≥ 5 antihypertensive agents. Individuals were classified as RfH or RH, and multivariate logistic regression models were constructed to examine the association between RfH and stroke. Results We evaluated a total of 137 patients; 81% were female, and 93,3% were Black or multiracial. The mean age was 64.4 years. Stroke was more prevalent in the RfH group (35.7%), in comparison to the RH group (12.8%) (p value = 0.01). Unadjusted odds ratio (OR) and 95% confidence interval (CI) for factors associated with stroke were RfH (OR 3.77; 95% CI 1.45 to 9.80), systolic BP (OR 1.02; 95% CI 1.002 to 1.04) and diastolic BP (OR 1.03; 95% CI 1.001 to 1.06). Adjusted OR for factors associated with stroke were RfH (OR 3.55; 95% CI 1.02 to 12.42), systolic BP (OR 1.02; 95% CI 0.99 to 1.05) and diastolic BP (OR 1.01; 95% CI 0.96 to 1.06). Conclusion RfH was associated with higher prevalence of stroke. Efforts are required to better understand this association to prevent adverse cardiovascular outcomes in these patients. (AU)

• FAPESP's process: 22/02339-4 - Physical training-regulated microRNAs as potential biomarkers and therapeutics of doxorubicin-induced cardiotoxicity in Breast Cancer: in vivo study, in vitro in iPS-derived cardiomyocytes and clinical with patient analysis
• Grantee: Alex Cleber Improta Caria
• Support Opportunities: Scholarships in Brazil - Post-Doctoral