Resistant Hypertension and Related Outcomes in a Cohort of Patients with Cardiorenal Multimorbidity Hospitalized in an Internal Medicine Ward.

IF 3.1 Q2 PERIPHERAL VASCULAR DISEASE High Blood Pressure & Cardiovascular Prevention Pub Date : 2023-11-01 Epub Date: 2023-11-27 DOI:10.1007/s40292-023-00609-x
Antonietta Gigante, Rosario Cianci, Claudia Brigato, Michele Melena, Erika Acquaviva, Ludovica Toccini, Chiara Pellicano, Edoardo Rosato, Maurizio Muscaritoli
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Abstract

Introduction: Resistant hypertension (RH) is characterized by the failure to reach a goal blood pressure despite the administration of three medications at maximally tolerated doses, one of which being a diuretic. RH can be observed in a variety of clinical conditions, such as heart failure and reduced renal function and may confer high cardiovascular risk.

Aim: To evaluate the prevalence of RH and its association with clinical outcomes; the primary outcome was in-hospital mortality and the composite outcome was all-cause of mortality and morbidity in a cohort of patients with cardiorenal multimorbidity hospitalized in an internal medicine ward.

Methods: We conducted a retrospective analysis of consecutive hypertensive patients with cardiorenal multimorbidity. The composite outcome incorporated all-cause of in-hospital mortality and occurrence of sepsis, pulmonary embolism, acute coronary syndrome, stroke and renal replacement therapy.

Results: We collected data in 141 inpatients with a mean age of 77 years ± 10 (males 65.9 %), estimated glomerular filtration rate of 34 ± 18.6 ml/min with length of stay of 17 ± 12 days. The prevalence of RH was 52.4%. In-hospital mortality was observed in 24 patients (17%) and the composite outcome occurred in 87 patients (61.7%) and among these 74 (85.1%) were patients with RH. Free survival for composite outcome was significantly higher in patients without RH than patients with RH (log rank 7.52, p = 0.006). Resistant hypertension was a risk factor for composite outcome [HR 1.857(C.I. 1.170-2.946, p = 0.009)].

Conclusion: In patients with cardiorenal multimorbidity there is a high proportion of RH that represents a risk factor for composite outcome but not for in-hospital mortality.

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在内科病房住院的心肾多病患者的顽固性高血压及其相关结局
导读:顽固性高血压(RH)的特点是,尽管以最大耐受剂量使用了三种药物,其中一种是利尿剂,但仍未能达到目标血压。RH可以在各种临床情况下观察到,如心力衰竭和肾功能下降,并可能导致心血管疾病的高风险。目的:评价RH患病率及其与临床预后的关系;主要结局是住院死亡率,复合结局是在内科病房住院的心肾多重疾病患者的全因死亡率和发病率。方法:我们对连续合并心肾多病的高血压患者进行回顾性分析。综合结果包括全因住院死亡率和脓毒症、肺栓塞、急性冠状动脉综合征、中风和肾脏替代治疗的发生。结果:我们收集了141例住院患者的资料,平均年龄为77岁±10岁(男性占65.9%),估计肾小球滤过率为34±18.6 ml/min,住院时间为17±12天。RH患病率为52.4%。住院死亡24例(17%),出现复合结局的87例(61.7%),其中RH患者74例(85.1%)。无RH患者的自由生存率显著高于RH患者(log rank 7.52, p = 0.006)。顽固性高血压是复合结局的危险因素[HR 1.857(C.I.)]1.170-2.946, p = 0.009)]。结论:在心肾多病患者中,RH的比例很高,这是复合结局的危险因素,但不是院内死亡率的危险因素。
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来源期刊
CiteScore
5.70
自引率
3.30%
发文量
57
期刊介绍: High Blood Pressure & Cardiovascular Prevention promotes knowledge, update and discussion in the field of hypertension and cardiovascular disease prevention, by providing a regular programme of independent review articles covering key aspects of the management of hypertension and cardiovascular diseases. The journal includes:   Invited ''State of the Art'' reviews.  Expert commentaries on guidelines, major trials, technical advances.Presentation of new intervention trials design.''Pros and Cons'' or round tables on controversial issues.Statements on guidelines from hypertension and cardiovascular scientific societies.Socio-economic issues.Cost/benefit in prevention of cardiovascular diseases.Monitoring of healthcare systems.News and views from the Italian Society of Hypertension (including abstracts).All manuscripts are subject to peer review by international experts. Letters to the editor are welcomed and will be considered for publication.
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