Abstract 4348252: GENDER DIFFERENCES IN THE IMPACT OF APPARENTLY RESISTANT HYPERTENSION ON TARGET ORGAN LESIONS AND PATIENT PROGNOSIS

Abstract

Introduction: Complications of arterial hypertension(AH) are more frequent in patients with resistant AH(RH), defined as blood pressure(BP) ≥ 140x90 mmHg, despite ≥ 3 antihypertensive drugs. Due several limitations for the diagnosis of true RH,apparently resistant hypertension (aRH) is defined as uncontrolled BP with ≥ 3 medications, regardless of BP values. It is not established whether there are differences between sexes in the main outcomes in patients with aRH. Objective: To evaluate end-organ damage (EOD), occurrence of cardiovascular events (CV), stroke, renal events, and all-cause mortality in patients with aRH according to sex. Methods: Retrospective analysis of 632 patients with aRH followed at a tertiary hospital. Differences between the sexes were studied regarding EOD, estimated glomerular filtration rate(eGFR), left ventricular hypertrophy(LVH) and ventricular function obtained by echocardiogram, major adverse CV events(MACE), stroke, progression of chronic kidney disease (CKD) and all-cause mortality. MACE was defined as the composite of myocardial infarction, percutaneous or surgical coronary artery intervention, and heart failure. The mean follow-up time was 6.43±2 years. Results: 357 (56.5%) women, mean age 52.6±11 years, BMI 30±5.8 kg/m2, BP at admission 171±29/100(74-142) mmHg, using 3.5±1 antihypertensives. Men had lower eGFR than women (73±26 vs. 69±24 mL/min/1.73m2,p < 0.01), LVH was similar in both sexes (59.8% men vs. 56.5% women), but left ventricular (LV) mass index was higher in men (124±28 g/m2 vs. 105.6±35 g/m2, p<0.01), and both LV diastolic (56% vs. 43.3%) and systolic (56.6% vs. 43.4%) dysfunction(EF<40%) were more prevalent in men (p<0.01). MACE occurred in 40.4% of patients, significantly more in women than in men (44.9% vs 34.6%,p<0.01); stroke predominant in women (16.1% vs. 11.3%); progression of CKD occurred in 25%. At follow-up, 175(27.6%) patients died. Logistic regression for MACE showed female gender(OR 1.51,95%CI 1.09-2) and obesity (1.48, 95%CI 1.07-2) as independent variables, while for all-cause mortality, the independent factors were diabetes(DM) (1.41, 95%CI 1.12-1.61), CKD (1.67, 95%CI 1.52-1.8), LVH (1.41, 95% 1.12-1.61), and age > 60 years (1.57, 95%CI 1.36-1.72). Conclusions: 1) Men with aRH have higher EOD severity than women, but women with aRH are more likely to have MACE than men. 2) In patients with aRH, all-cause mortality is associated with DM, CKD, LVH, and older age, but not with gender.