Abstract: TH-PO459

Clinical Characteristics and Outcomes Associated with Resistant Hypertension in the VA Million Veteran Program

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 303 CKD: Epidemiology, Outcomes - Cardiovascular


  • Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Edwards, Todd L., Vanderbilt University, Nashville, Tennessee, United States
  • Wilson, Otis D, Vanderbilt University, Nashville, Tennessee, United States
  • Tsao, Philip S, Stanford University, Nashville, Tennessee, United States
  • Wilson, Peter W, Emory University, Atlanta, Georgia, United States
  • O'Donnell, Christopher Joseph, Boston Veterans Administration, Boston, Massachusetts, United States
  • Hung, Adriana, Vanderbilt University, Nashville, Tennessee, United States

Group or Team Name

  • On behalf of VA Million Veteran Program

The prevalence of resistant hypertension (RH), the characteristics of patients with RH and the association of RH with clinical outcomes is unclear.


Methods: From among 510,167 veterans enrolled in the Million Veteran Program (MVP), we identified 27,381 patients with the RH phenotype by using clinical data: failure to achieve outpatient BP <140/90 mmHg with three antihypertensive drugs (AHD), one being a thiazide , or success with 4 or more drugs, excluding BP measurements when pain score was >5, when interfering medications were prescribed and excluding patients with confounding medical conditions (CKD, secondary HTN, sleep apnea, urinary obstruction, adrenal, thyroid and parathyroid over-activity). Patients with RH were compared to 268,520 patients with non-resistant HTN (NRH). We examined associations with all-cause mortality, heart attacks (MI), strokes and ESRD in crude (Model 1) and multivariable Cox proportional hazards models adjusted for baseline demographics, comorbid conditions and estimated GFR (Model 2). The role of BP control was examined by additional adjustment for SBP, DBP and number of antihypertensive drugs (AHD) (Model 3).


The SBP/DBP (mean/SD) and number of AHD (median/IQR) in RH vs. NRH patients were 143±18/81±13 vs. 134±12/79±11 mmHg and 4 (3-4) vs. 1 (1-2), respectively. In Model 2 RH (referent: NRH) was associated with similar mortality but significantly higher risk of MI, stroke and ESRD (Figure). The higher risks of MI and stroke were mediated by the higher BP seen in RH patients, and became non-significant after additional adjustment in Model 3. The higher risk of ESRD persisted in Model 3 (Figure).


RH is associated with higher risk of incident MI, stroke and ESRD. Better BP control in patients with RH may alleviate the higher risk of MI and stroke. Further studies are needed to explain the mechanisms underlying the higher risk of ESRD in RH.


  • Veterans Affairs Support