Characteristics of Resistant Hypertension in a Large, Ethnically Diverse Hypertension Population of an Integrated Health System
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Objective To evaluate the prevalence of and characterize resistant hypertension in a large representative population with successful hypertension management and reliable health information.Patient and methods We performed a cross-sectional study using clinical encounter, laboratory, and administrative information from the Kaiser Permanente Southern California health system between January 1, 2006, and December 31, 2007. From individuals older than 17 years with hypertension, resistant hypertension was identified and prevalence was determined. Multivariable logistic regression was used to calculate odds ratios (ORs), with adjustments for demographic characteristics, clinical variables, and medication use.Results Of 470,386 hypertensive individuals, 60,327 (12.8%) were identified as having resistant disease, representing 15.3% of those taking medications. Overall, 37,061 patients (7.9%) had uncontrolled hypertension while taking 3 or more medicines. The ORs (95% CIs) for resistant hypertension were greater for black race (1.68 [1.62-1.75]), older age (1.11 [1.10-1.11] for every 5-year increase), male sex (1.06 [1.03-1.10]), and obesity (1.46 [1.42-1.51]). Medication adherence rates were higher in those with resistant hypertension (93% vs 89.8%; P<.001). Chronic kidney disease (OR, 1.84; 95% CI, 1.78-1.90), diabetes mellitus (OR, 1.58; 95% CI, 1.53-1.63), and cardiovascular disease (OR, 1.34; 95% CI, 1.30-1.39) were also associated with higher risk of resistant hypertension.Conclusion In a more standardized hypertension treatment environment, we observed a rate of resistant hypertension comparable with that of previous studies using more fragmented data sources. Past observations have been limited due to nonrepresentative populations, reliability of the data, heterogeneity of the treatment environments, and less than ideal control rates. This cohort, which was established using an electronic medical record-based approach, has the potential to provide a better understanding of resistant hypertension and outcomes.
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Demographic correlates of resistant hypertension include black race, older age, and male sex.
“Demographic correlates of RH include black race, older age, and male sex.38”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [38]
In a large Kaiser Permanente Southern California data set, obesity (BMI ≥30 kg/m2) is an independent risk factor for resistant hypertension (odds ratio, 1.62; 95% CI, 1.42-1.51).
“Finally, in a large data set (>470 000) from the Kaiser Permanente Southern California health system, obesity (BMI ≥30 kg/m2) was also found to be an independent risk factor for RH (odds ratio, 1.62; 95% CI, 1.42–1.51).38”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [38]
Chronic renal insufficiency is a well-established cause of heightened salt sensitivity of blood pressure and has been repetitively linked to apparent treatment-resistant hypertension.
“Further indirect evidence can be derived from large population studies in which chronic renal insufficiency, a well-established cause of heightened salt sensitivity of BP, has been repetitively linked to aTRH.13,38,152”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [38]
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- Authors
- Sim, J. J., Bhandari, S. K., Shi, J., Liu, I. L. A., Calhoun, D. A., McGlynn, E. A., Kalantar-Zadeh, K., & Jacobsen, S. J.
- Affiliations
- Kaiser Permanente (US)
- University of Alabama at Birmingham (US)
- Corresponding author
- Sim, John J.
- Venue
- Mayo Clinic Proceedings
- Publisher
- Elsevier BV
- Published
- 2013-10
- Volume
- 88
- Issue
- 10
- Pages
- 1099-1107
- ISSN
- 0025-6196 (ISSN-L)
- PMC
- PMC3909733
- OpenAlex
- W2012643476
- Cited by
- 206
- References
- 37
- Citations by year
- 2026: 9 · 2025: 6 · 2024: 14 · 2023: 14 · 2022: 14 · 2021: 11 · 2020: 26 · 2019: 26 · 2018: 19 · 2017: 24 · 2016: 15 · 2015: 13 · 2014: 13 · 2013: 1
- FWCI
- 9.52
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Mayo Clinic Proceedings (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion, cc-by)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK078106, K24DK091419)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Keywords
- resistant hypertension, prevalence, uncontrolled hypertension, antihypertensive medication use, medication adherence, chronic kidney disease, diabetes mellitus, cardiovascular disease, obesity, racial disparities, Kaiser Permanente, integrated health system, electronic medical record data
- MeSH terms
- Aged, Antihypertensive Agents, Black or African American, California, Cardiovascular Diseases, Coronary Vasospasm, Cross-Cultural Comparison, Diabetes Mellitus, Drug Resistance, Female, Humans, Hypertension, Male, Nutrition Surveys, Obesity, Comorbidity, Prevalence, Logistic Models, Age Distribution, Sex Distribution, Delivery of Health Care, Integrated
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