Relationship Between Home Blood Pressure Monitoring–Confirmed Resistant Hypertension and Cardiovascular Prognosis

BACKGROUND: Cardiovascular prognosis in people with drug-resistant hypertension, defined by office and home blood pressure, has not been fully evaluated. This Japan Morning Surge–Home Blood Pressure study data analysis evaluated the cardiovascular event rate in patients with drug-resistant hypertension defined using office and home blood pressure. METHODS: The incidence of cardiovascular events (stroke, coronary artery disease, congestive heart failure, aortic dissection) in participants with true resistant hypertension (office blood pressure ≥140/90 mm Hg and home blood pressure ≥135/85 mm Hg during treatment with ≥3 antihypertensives, including a diuretic) was determined and compared with other hypertension subgroups. RESULTS: During mean 6.2 years’ follow-up in 4278 participants (mean age, 64.9±10.9 years; 46.9% male), cardiovascular events included stroke (n=96), coronary artery disease (n=125), congestive heart failure (n=42), aortic dissection (n=8), and sudden death (n=15). The incidence of cardiovascular events in patients with home blood pressure monitoring–confirmed resistant hypertension was 34.7 per 1000 person-years (significantly higher than in those with well-controlled hypertension on ≥3 drugs including a diuretic; 11.9 per 1000 person-years [ P <0.001]). In the home blood pressure monitoring–confirmed resistant hypertension group, cardiovascular event incidence was highest in those with versus without cardiovascular disease history (39.4 versus 22.7 per 1000 person-years). CONCLUSIONS: These data showed that home blood pressure–confirmed resistant hypertension was associated with a high incidence of cardiovascular events over time, especially in the presence of a cardiovascular disease history. The relevance of home blood pressure monitoring for defining resistant hypertension and treatment strategies, especially compared with ambulatory blood pressure monitoring, remains to be determined. REGISTRATION: URL: https://www.umin.ac.jp/ctr ; Unique identifier: UMIN000000894.