'Raison d'être'

Jean Marco invites you to share your comments on the result of the Reduction of Atherothrombosis for Continued Health ( REACH ) registry recently published
« Resistant hypertension: a frequent and ominous finding among hypertensive patients with atherothrombosis » Eur Heart J (2013) 34 (16): 1204-1214.

The REACH registry, one of the largest contemporary outpatient registries, which was initiated to evaluate patients who represent the entire spectrum of atherosclerotic clinical syndromes,  includes 53,530 patients, with an annual follow-up at 1, 2, 3 and 4 years. Patients without a 4-year follow-up were censored at the time of the last visit, unless they had already experienced a cardiac event.

The primary outcome was a composite of cardiovascular death, myocardial infarction, or stroke over 4 years.

From the REACH Registry, 12.7% met the definition of resistant hypertension patients with RH who had higher risk of the primary endpoint of cardiovascular death/MI/stroke at 4 years, when compared with patients who had non-resistant hypertension (likely due to difference in non-fatal stroke).

All cardiovascular hospitalisations were higher in patients with RH due to an increase in hospitalisation for congestive heart failure.

When a more conservative definition (systolic BP > 160 mmHg on > 3 agents ) was used for RH, the overall prevalence decreased to 6.0%, but was still associated with a significant risk for the primary endpoint. When the more liberal definition (uncontrolled on 3 agents, any BP on > 4 agents) was implemented, the overall prevalence increased to 21.6%. Again, RH was significantly associated with an elevated risk of primary endpoint, including all-cause  mortality.

This large registry showed that Resistant Hypertension is  a common finding, and is associated with an increase in the long-term risk of adverse cardio-vascular outcomes.

Consequently, greater efforts toward novel strategies to improve BP control are required in patient population  which accord with to the 'raison d'être' of the RHC initiative.

Join the discussion; post your comments and share your views.