Prevalence of Optimal Treatment Regimens in Patients With Apparent Treatment-Resistant Hypertension Based on Office Blood Pressure in a Community-Based Practice Network
Open accessAbstract
Hypertensive patients with clinical blood pressure (BP) uncontrolled on ≥3 antihypertensive medications (ie, apparent treatment-resistant hypertension [aTRH]) comprise ≈28% to 30% of all uncontrolled patients in the United States. However, the proportion receiving these medications in optimal doses is unknown; aTRH is used because treatment adherence and measurement artifacts were not available in electronic record data from our >200 community-based clinics Outpatient Quality Improvement Network. This study sought to define the proportion of uncontrolled hypertensives with aTRH on optimal regimens and clinical factors associated with optimal therapy. During 2007–2010, 468 877 hypertensive patients met inclusion criteria. BP <140/<90 mm Hg defined control. Multivariable logistic regression was used to assess variables independently associated with optimal therapy (prescription of diuretic and ≥2 other BP medications at ≥50% of maximum recommended hypertension doses). Among 468 877 hypertensives, 147 635 (31.5%) were uncontrolled; among uncontrolled hypertensives, 44 684 were prescribed ≥3 BP medications (30.3%), of whom 22 189 (15.0%) were prescribed optimal therapy. Clinical factors independently associated with optimal BP therapy included black race (odds ratio, 1.40 [95% confidence interval, 1.32–1.49]), chronic kidney disease (1.31 [1.25–1.38]), diabetes mellitus (1.30 [1.24–1.37]), and coronary heart disease risk equivalent status (1.29 [1.14–1.46]). Clinicians more often prescribe optimal therapy for aTRH when cardiovascular risk is greater and treatment goals lower. Approximately 1 in 7 of all uncontrolled hypertensives and 1 in 2 with uncontrolled aTRH are prescribed ≥3 BP medications in optimal regimens. Prescribing more optimal pharmacotherapy for uncontrolled hypertensives including aTRH, confirmed with out-of-office BP, could improve hypertension control.
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Among treated adults with hypertension, prevalent apparent treatment-resistant hypertension occurs in 15% to 18% of clinic-based samples.
“Among treated adults with hypertension, prevalent aTRH occurs in ≈12% to 15% of population-based13–16 and 15% to 18% of clinic-based reports.17–20”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [20]
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- Authors
- Egan, B. M., Zhao, Y., Li, J., Brzezinski, W. A., Todoran, T. M., Brook, R. D., & Calhoun, D. A.
- Affiliations
- Medical University of South Carolina (US)
- Venue
- Hypertension
- Published
- 2013-10
- Volume
- 62
- Issue
- 4
- Pages
- 691-697
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- PMC
- PMC4066303
- OpenAlex
- W2142011051
- Cited by
- 158
- References
- 37
- Citations by year
- 2026: 4 · 2025: 1 · 2024: 13 · 2023: 16 · 2022: 12 · 2021: 6 · 2020: 10 · 2019: 8 · 2018: 12 · 2017: 14 · 2016: 21 · 2015: 16 · 2014: 22 · 2013: 3
- FWCI
- 14.04
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- Centers for Disease Control and Prevention
- National Heart, Lung, and Blood Institute (R34HL105880, R01HL091841, HL091841, HL105880)
- National Institute of Neurological Disorders and Stroke (NS058728, U01NS058728)
- 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 › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- apparent treatment-resistant hypertension, uncontrolled hypertension, office blood pressure, diuretics, chronic kidney disease, diabetes mellitus, coronary heart disease risk, racial disparities, hypertension control, community clinics
- MeSH terms
- Aged, Antihypertensive Agents, Black or African American, Blood Pressure, Blood Pressure Determination, Community Health Services, Female, Humans, Hypertension, Male, Middle Aged, Risk Factors, United States, Prevalence, Treatment Failure, Medication Adherence
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