Resistance and control of hypertension in patients with heart failure according to the PRIORITY-HF study

Aim. To assess the frequency, associated factors, features of hypertension (HTN) treatment and prognosis depending on blood pressure (BP) control and resistance to antihypertensive therapy (AHT) in outpatients with heart failure (HF).

Material and methods. This retrospective analysis of data from 19938 PRIORITYHF study participants with BP data at Visit 1 was performed. No BP control was defined as systolic and/or diastolic BP ≥140 and/or 90 mm Hg. In the absence of BP control on triple AHT (renin-angiotensin-aldosterone system inhibitor + calcium channel blocker + thiazide/thiazide-like diuretic) or BP control while taking triple AHT in combination with at least one other antihypertensive class, resistant HTN (uncontrolled and controlled, respectively) was diagnosed.

Results. HTN was diagnosed in 17750 (89,0%) patients, of which 32,1% were uncontrolled and 10,2% were resistant (including 4,5% as uncontrolled). In multivariate logistic regression, obesity, type 2 diabetes, and more severe congestion increased the probability of uncontrolled resistant HTN. Initiation of at least one new class of antihypertensives was noted in 2005 (35,2%) patients with uncontrolled HTN and in 152 (19%) patients with uncontrolled resistant HTN. Loop diuretics, mineralocorticoid receptor antagonists, and beta-blockers were most often added to therapy. Underuse of quadruple therapy was noted in HF with reduced ejection fraction, especially in uncontrolled HTN. In the overall group, the death risk was lower in uncontrolled HTN — odds ratio (OR) 0,798 [95% confidence interval (CI) 0,6810,935]. An independent association was found between uncontrolled resistant HTN and an increased probability of all-cause (OR 1,406 [95% CI 1,223-1,615], cardiovascular (OR 1,4 [95% CI 1,172-1,673]) and HF-related (OR 1,475 [95% CI 1,088-

2]) hospitalizations with no significant differences between subgroups in ejection fraction (p for correlation >0,05).

Conclusion. No BP control was detected in every third patient with HF and HTN. The association of uncontrolled resistant HTN with metabolic comorbidities, risk of hospitalization, and the need for multicomponent therapy require increased awareness among physicians about the tactics of managing patients with a combination of different phenotypes of HF and HTN.

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