The Characteristic Of Resistant Hypertension And The Prognostic Factors

Objective:To evaluate the clinical feathers of the resistant hypertension through comparing with the database of hypertension and investigate the prognostic factors.Method:Hospitalized patients with hypertension from April2010to April2013in cardiology of the Second Hospital of Tianjin Medical University who treated were enrolled, and divided into two groups:resistant hypertension groups (RH,n=264) and non-resistant hypertension groups (non-RH,n=322) according to the ambulatory blood pressure monitoring (ABPM) and antihypertension drugs. The clinical data included general information, biochemical criterion, the duration and anti-hypertensi-on drugs, the index of echocardiographic, the combined disease and the data of ABPM to compare between the groups. Following up the death and the cardiovascul-ar disease, primary endpoints were all-cause mortalities and cardiovascular mortalitie-s, second endpoints were a composite of fatal and nonfatal cardiovascular events, we analysed the influence factors of prognosis using Cox regression model.Results:1. The levels of age(65.05±13.34), the proportion of drinking(28.8%), body mass index(BMI)(26.77±4.13), the duration (15.74±11.89), the proportion of diabetic(DM)(37.4%), the proportion of stroke(32.7%), the proportion of metabolic syndrome(MS)(91.7%), the proportion of left ventricle hypertrophy(32.6%),24hours systolic blood pressure (24hSBP)(143.47±14.64),24hours diastolic blood pressure (24hDBP)(75.00±12.44), heart rate(HR)(70.34±9.60), pulse pressure (PP)(68.87±15.60), diastolic blood pressure standard deviation (DBPSD)(9.71±2.75), the proportion of non-dipper (ND)(67.8%), the proportion of moring surge(39.4%), ambulatory arterial stiffness index(AASI)(0.53±0.14) were higher in RH group than those of non-RH group (61.48±10.94,20.9%,25.83±3.44,9.18±9.70,22.9%,18.7%,85.7%,15.2%,127.04±12.45,71.76±9.28,68.81±10.29,57.41±29.86,9.40±2.24,57.1%,21.1%and0.49±0.13, respectively, P<0.05). These was a significantly lower in estimated glomerular filtration rate(eGFR)(99.23±24.93) in RH group than that in non-RH group (85.98±26.65, P<0.01). In Logistic regression analysis model, influence factors of RH were drinking, stroke, eGFR, left ventricle hypertrophy and24hSBP(P<0.05).2. The analysis of influence factors of prognosis of the RH patients:There are264cases of RH in total, including thirty-two patients (12.1%) were lost to follow-up. After median follow-up21.19±8.31months,12patients (5.17%) all-cause deaths occurred and8patients (3.45%) from cardiovascular disease,34patients (14.66%) reached the second endpoints.2.1All-cause mortalities analysis:Cox regression multivariate analysis showed that age (HR=1.144,95%CI:1.014-1.218), ND(HR=3.745,95%CI:1.607～9.534) and AASI (HR=1.996,95%CI:1.133～3.518) had significant effects on the overall survival of patients. In Kaplan-Meier analyse of survival curves, patients with high AASI had a significantly worse prognosis regarding the all-cause death (P<0.05).2.2Cardiovascular mortalities analysis:Cox regression multivariate analysis showed that age(HR=1.261,95%CI:1.090‘1.458), and ND (HR=1.691,95%CI:1.0141.899) had significant effects on the cardiovascular survival of patients (P<0.05).2.3Fatal and non-fatal cardiovascular events analysis:Cox regression multivariate analysis showed that ND (HR=3.462,95%CI:1.285～9.328), reverse-dipper (RD)(HR=3.014,95%CI:1.014±21.699) and AASI (HR=1.872,95%CI:1.353／2.789) had significant effects on the occur of fatal and non-fatal cardiovascular events. In Kaplan-Meier analyse of survival curves.patients with high AASI had a significantly worse prognosis regarding the fatal and non-fatal cardiovascular events (P<0.05).Conclusion1. RH groups has its own characteristics and the independent predictors of RH were drinking, long duration, stroke, renal failure, left ventricular hypertrophy, high24hSBP.2. The risk factors that influence the total survival of RH patients include age, ND and AASI, age and ND may relate to cardiovascular mortalities in RH patients. ND and RD and high AASI may relate to cardiovascular events in RH patients.