The association between fibrotic diseases and treatment resistant hypertension in England
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Aims
Multimorbidity has been identified as a research priority in recent years; fibrosis (progressive organ scarring) is one mechanism that may underpin multimorbidity. Some studies suggest hypertension could be fibrotic, particularly severe hypertension (uncontrollable with medications); however, it is not currently known whether severe hypertension is associated with fibrotic conditions. The objective is to investigate whether treatment-resistant hypertension is associated with fibrotic conditions.
Methods and results
We used the Clinical Practice Research Datalink Aurum primary care database to define a cohort of people with hypertension during 2015. We determined the percentage of people who had conditions with fibrotic manifestations and explored differences respective to hypertension control. We applied multivariable logistic regression to analyse associations (P < 0.001) between hypertension control and each fibrotic condition, respectively. Of 1 340 495 people with hypertension during 2015, 83.50% (n = 1 119 333) had managed hypertension either by lifestyle or by medication; 16.50% (n = 221 162) had treatment-resistant hypertension. Fibrotic conditions were more common {75.40% [95% confidence interval (CI): 75.20–75.60] vs. 68.90% (95% CI: 68.81–70.01)} in people with treatment-resistant hypertension compared with those with managed hypertension. We found that treatment-resistant hypertension was associated with cardiomyopathy (ORadj: 1.85, 95% CI: 1.81–1.90), both Type 1 and Type 2 diabetes (ORadj: 1.49, 95% CI: 1.44–1.55, ORadj: 1.61, 95% CI: 1.60–1.63, respectively), liver fibrosis (ORadj: 1.52, 95% CI: 1.46–1.58), valve fibrosis (ORadj: 1.41, 95% CI: 1.37–1.44), and urinary fibrosis (ORadj: 1.41, 95% CI: 1.36–1.47).
Conclusion
The proportion of people with fibrotic conditions was greater in those with treatment-resistant hypertension than managed hypertension. The identified associations between treatment-resistant hypertension and fibrotic conditions may point to common disease pathways, which should be further explored to understand shared mechanisms.
Multimorbidity has been identified as a research priority in recent years; fibrosis (progressive organ scarring) is one mechanism that may underpin multimorbidity. Some studies suggest hypertension could be fibrotic, particularly severe hypertension (uncontrollable with medications); however, it is not currently known whether severe hypertension is associated with fibrotic conditions. The objective is to investigate whether treatment-resistant hypertension is associated with fibrotic conditions.
Methods and results
We used the Clinical Practice Research Datalink Aurum primary care database to define a cohort of people with hypertension during 2015. We determined the percentage of people who had conditions with fibrotic manifestations and explored differences respective to hypertension control. We applied multivariable logistic regression to analyse associations (P < 0.001) between hypertension control and each fibrotic condition, respectively. Of 1 340 495 people with hypertension during 2015, 83.50% (n = 1 119 333) had managed hypertension either by lifestyle or by medication; 16.50% (n = 221 162) had treatment-resistant hypertension. Fibrotic conditions were more common {75.40% [95% confidence interval (CI): 75.20–75.60] vs. 68.90% (95% CI: 68.81–70.01)} in people with treatment-resistant hypertension compared with those with managed hypertension. We found that treatment-resistant hypertension was associated with cardiomyopathy (ORadj: 1.85, 95% CI: 1.81–1.90), both Type 1 and Type 2 diabetes (ORadj: 1.49, 95% CI: 1.44–1.55, ORadj: 1.61, 95% CI: 1.60–1.63, respectively), liver fibrosis (ORadj: 1.52, 95% CI: 1.46–1.58), valve fibrosis (ORadj: 1.41, 95% CI: 1.37–1.44), and urinary fibrosis (ORadj: 1.41, 95% CI: 1.36–1.47).
Conclusion
The proportion of people with fibrotic conditions was greater in those with treatment-resistant hypertension than managed hypertension. The identified associations between treatment-resistant hypertension and fibrotic conditions may point to common disease pathways, which should be further explored to understand shared mechanisms.
Date Issued
2026-05-01
Date Acceptance
2025-01-24
Citation
European Journal of Preventive Cardiology, 2026, 33 (7), pp.1227-1235
ISSN
2047-4873
Publisher
Oxford University Press
Start Page
1227
End Page
1235
Journal / Book Title
European Journal of Preventive Cardiology
Volume
33
Issue
7
Copyright Statement
© The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
License URL
Identifier
10.1093/eurjpc/zwaf068
Publication Status
Published
Article Number
zwaf068
Date Publish Online
2025-02-13