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. 2023 Jan 25;9(2):e13258.
doi: 10.1016/j.heliyon.2023.e13258. eCollection 2023 Feb.

Characteristics, management, and blood pressure control in patients with apparent resistant hypertension in the US

Eric M Ammann  1 , Ellen S O'Brien  2 , Dejan Milentijevic  3 , Akshay A Kharat  3 , Darren A Talbot  4 , William Canovatchel  5 , Lloyd Haskell  1 , Nabil S Andrawis  6
Affiliations

Characteristics, management, and blood pressure control in patients with apparent resistant hypertension in the US

Eric M Ammann et al. Heliyon. .

Abstract

Background: Per treatment guidelines, resistant hypertension is defined as uncontrolled blood pressure (BP) while taking 3 concomitant antihypertensives (AHTs) or controlled BP while taking ≥4 AHTs. Characteristics, AHT therapy use, and BP control were analyzed in US patients with hypertension who were prescribed ≥3 classes of AHT medications.

Methods: This retrospective analysis of the Optum® Electronic Health Record Database evaluated patients ≥18 years of age with a diagnosis of hypertension classified based on the number of prescribed AHT medication classes (3, 4, or ≥5). For the primary analysis, uncontrolled hypertension was defined as systolic BP (SBP) ≥140 mmHg or diastolic BP (DBP) ≥90 mmHg. For secondary analyses, uncontrolled hypertension was defined as SBP ≥130 mmHg or DBP ≥80 mmHg.

Results: 207,705 patients with hypertension and concurrent use of ≥3 AHT medication classes were included. Diuretics, beta blockers, ACE inhibitors and/or ARBs, and CCBs were the most prescribed classes; thiazides and thiazide-like agents were the most prescribed diuretics. Among patients who were prescribed 3, 4, or ≥5 AHT medication classes, approximately 70% achieved a BP goal of <140/90 mmHg; approximately 40% achieved BP <130/80 mmHg. After ≥1 year of follow-up, the number of concurrent AHT medication classes was unchanged from baseline in the majority of patients and the prevalence of uncontrolled hypertension (≥140/90 mmHg) was similar.

Conclusions: This study illustrates suboptimal BP control in many patients with apparent resistant hypertension despite the use of multidrug regimens and suggests a need for new drug classes and regimens that effectively manage resistant hypertension.

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Conflict of interest statement

The authors declare the following conflict of interests: EMA, ESO, DM, AAK, WC, and LH are employees of Janssen and may be Johnson & Johnson stockholders. DAT is an employee of Idorsia Pharmaceuticals and is an Idorsia stockholder. NSA has provided consultancy advice to Janssen.

Figures

Fig. 1
Fig. 1
Study design. AHT, antihypertensive; BP, blood pressure.
Fig. 2
Fig. 2
Percentage of (A) all patients and (B) patients stratified by diuretic use achieving BP goals ( <140/90 mmHg or <130/80 mmHg) by number of prescribed AHT medication classes. AHT, antihypertensive; BP, blood pressure. *P < 0.0001 across BP treatment goal groups by number of AHT medication classes. †P < 0.0001 across number of AHT medication classes groups by diuretic use.
Fig. 3
Fig. 3
Number of AHT medication classes prescribed after 1 year of follow-up by number of AHT medication classes prescribed at baseline. AHT, antihypertensive. *P < 0.0001 across all groups by number of medication classes. †Patients with ≥1 year of follow-up.
Fig. 4
Fig. 4
Percentage of patients achieving BP goal (<140/90 mmHg) at baseline and after 1 year of follow-up by number of AHT medication classes at baseline. AHT, antihypertensive; BP, blood pressure. *Includes patients with 1 year of follow-up and 2 outpatient BP assessments at 1 year.
See this image and copyright information in PMC

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