Cardiovascular outcome in treated hypertensive patients with responder, masked, false resistant, and true resistant hypertension

Background: The aim of this study was to evaluate the cardiovascular outcome in apparently responder hypertensive patients with responder and masked hypertension, and in apparently resistant hypertensive patients with false and true resistant hypertension. Methods: The occurrence of fatal and nonfatal cardiovascular events was evaluated in 340 patients with responder hypertension (clinic blood pressure [BP] < 140/90 mm. Hg and daytime BP < 135/85 mm. Hg), 126 with masked hypertension (clinic BP < 140/90 mm Hg and daytime BP > 135 or 85 mm Hg), 146 with false resistant hypertension (clinic BP :140 or 90 mm Hg and daytime BP < 135/85 mm Hg), and 130 with true resistant hypertension (clinic BP 140 or 90 mm Hg and daytime BP > 135 or 85 mm Hg). Results: During follow-up period (4.98 +/- 2.9 years) the event-rate per 100 patient-years was 0.87, 2.42, 1.2: and 4.1 in patients with responder, masked, false resistant, and true resistant hypertension, respectively. After adjustment for several covariates, including clinic BP (forced into the model), Cox regression analysis showed that cardiovascular risk was significantly higher in masked hypertension (masked versus responder hypertension, relative risk [RR] 2.28, 95% confidence interval [CI] 1.1-4.7, P <.05) and in true resistant hypertension (true resistant versus responder hypertension, RR 2.94, 95% CI 1.02-18.41, P <.05), whereas there was no significant difference between false resistant and responder hypertension. Conclusions: This study shows that patients with masked hypertension are at higher risk than those with responder hypertension, and that those with false resistant hypertension are at lower risk than those with true resistant hypertension. Ambulatory BP monitoring should be performed in treated hypertensive patients to obtain a better prognostic stratification. Am J Hypertens 2005;18: 1422-1428 (c) 2005 American Journal of Hypertension, Ltd.