Resistant Hypertension Revisited: A Comparison of Two University-Based Cohorts
More than a decade ago, we found that a suboptimal medication regimen was the leading cause of resistant hypertension (RH) among patients referred to a tertiary care clinic. Since then, lower blood pressure (BP) goals have been recommended, suggesting that more patients may have RH. To assess whethe...
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| Veröffentlicht in: | American journal of hypertension 2005-05, Vol.18 (5), p.619-626 |
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| creator | Garg, Jay P. Elliott, William J. Folker, Amy Izhar, Munavvar Black, Henry R. |
| description | More than a decade ago, we found that a suboptimal medication regimen was the leading cause of resistant hypertension (RH) among patients referred to a tertiary care clinic. Since then, lower blood pressure (BP) goals have been recommended, suggesting that more patients may have RH. To assess whether the reasons for and treatment of RH have changed, we determined the frequency of various causes of resistance, the proportion of patients achieving goal BP, and the changes made in antihypertensive regimens.
The charts of all new patients seen at the RUSH University Hypertension Center between January 1, 1993, and November 1, 2001, were reviewed for strict criteria for RH: 1) physician referral for uncontrolled hypertension; 2) BP ≥140/90 mm Hg despite use of three antihypertensive drugs; and 3) at least one follow-up visit. Patients were followed-up until goal BP was achieved on two consecutive visits or their last visit or until March 2002.
Of 1281 patients, 141 met criteria for RH. A cause of resistance was found in 94% of cases, including the following: drug-related causes (58%); nonadherence (16%); psychological causes (9%); office resistance (ie, in-clinic BP readings that were higher than goal despite treatment with antihypertensive medications and despite normotensive BP outside of the clinic as demonstrated by 24-h ambulatory BP monitoring) (6%); and secondary hypertension (5%). Overall, 53% of patients had their BP controlled to |
| doi_str_mv | 10.1016/j.amjhyper.2004.11.021 |
| format | Article |
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The charts of all new patients seen at the RUSH University Hypertension Center between January 1, 1993, and November 1, 2001, were reviewed for strict criteria for RH: 1) physician referral for uncontrolled hypertension; 2) BP ≥140/90 mm Hg despite use of three antihypertensive drugs; and 3) at least one follow-up visit. Patients were followed-up until goal BP was achieved on two consecutive visits or their last visit or until March 2002.
Of 1281 patients, 141 met criteria for RH. A cause of resistance was found in 94% of cases, including the following: drug-related causes (58%); nonadherence (16%); psychological causes (9%); office resistance (ie, in-clinic BP readings that were higher than goal despite treatment with antihypertensive medications and despite normotensive BP outside of the clinic as demonstrated by 24-h ambulatory BP monitoring) (6%); and secondary hypertension (5%). Overall, 53% of patients had their BP controlled to <140/90 mm Hg, largely from regimen optimization and intensification, proper use of diuretics, and on average 4.1 ± 1 antihypertensive medications (3.7 ± 0.9 on referral).
These data are strikingly similar to those from our previous study of RH, in which a suboptimal medication regimen was the most common reason for resistance. Goal BP was most commonly achieved after optimizing the diuretic regimen and increasing the number of medications, suggesting that physicians should use these measures to attain the recommended lower BP goals If goal BP is not reached, referral to a clinical hypertension specialist may be appropriate.</description><identifier>ISSN: 0895-7061</identifier><identifier>EISSN: 1879-1905</identifier><identifier>EISSN: 1941-7225</identifier><identifier>DOI: 10.1016/j.amjhyper.2004.11.021</identifier><identifier>PMID: 15882544</identifier><identifier>CODEN: AJHYE6</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adult ; Aged ; Antihypertensive Agents - administration & dosage ; Arterial hypertension. Arterial hypotension ; Biological and medical sciences ; Blood and lymphatic vessels ; Blood Pressure - drug effects ; Cardiology. Vascular system ; Clinical manifestations. Epidemiology. Investigative techniques. Etiology ; Cohort Studies ; Drug Resistance ; drug therapy/combination ; Female ; Follow-Up Studies ; Fundamental and applied biological sciences. Psychology ; Hemodynamics. Rheology ; Humans ; hypertension ; Hypertension - drug therapy ; Male ; Medical sciences ; MESH headings: antihypertensive agents/therapeutic use ; Middle Aged ; Patient Compliance ; Vertebrates: cardiovascular system</subject><ispartof>American journal of hypertension, 2005-05, Vol.18 (5), p.619-626</ispartof><rights>2005 American Journal of Hypertension, Ltd.</rights><rights>American Journal of Hypertension, Ltd. © 2005 by the American Journal of Hypertension, Ltd. 2005</rights><rights>2005 INIST-CNRS</rights><rights>Copyright Nature Publishing Group May 2005</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c576t-d87dceca4d8cf60dffe865e641751d86c85e8d5fc696f523d913cbb55c8938f53</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=16779074$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15882544$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Garg, Jay P.</creatorcontrib><creatorcontrib>Elliott, William J.</creatorcontrib><creatorcontrib>Folker, Amy</creatorcontrib><creatorcontrib>Izhar, Munavvar</creatorcontrib><creatorcontrib>Black, Henry R.</creatorcontrib><creatorcontrib>RUSH University Hypertension Service</creatorcontrib><title>Resistant Hypertension Revisited: A Comparison of Two University-Based Cohorts</title><title>American journal of hypertension</title><addtitle>AJH</addtitle><description>More than a decade ago, we found that a suboptimal medication regimen was the leading cause of resistant hypertension (RH) among patients referred to a tertiary care clinic. Since then, lower blood pressure (BP) goals have been recommended, suggesting that more patients may have RH. To assess whether the reasons for and treatment of RH have changed, we determined the frequency of various causes of resistance, the proportion of patients achieving goal BP, and the changes made in antihypertensive regimens.
The charts of all new patients seen at the RUSH University Hypertension Center between January 1, 1993, and November 1, 2001, were reviewed for strict criteria for RH: 1) physician referral for uncontrolled hypertension; 2) BP ≥140/90 mm Hg despite use of three antihypertensive drugs; and 3) at least one follow-up visit. Patients were followed-up until goal BP was achieved on two consecutive visits or their last visit or until March 2002.
Of 1281 patients, 141 met criteria for RH. A cause of resistance was found in 94% of cases, including the following: drug-related causes (58%); nonadherence (16%); psychological causes (9%); office resistance (ie, in-clinic BP readings that were higher than goal despite treatment with antihypertensive medications and despite normotensive BP outside of the clinic as demonstrated by 24-h ambulatory BP monitoring) (6%); and secondary hypertension (5%). Overall, 53% of patients had their BP controlled to <140/90 mm Hg, largely from regimen optimization and intensification, proper use of diuretics, and on average 4.1 ± 1 antihypertensive medications (3.7 ± 0.9 on referral).
These data are strikingly similar to those from our previous study of RH, in which a suboptimal medication regimen was the most common reason for resistance. Goal BP was most commonly achieved after optimizing the diuretic regimen and increasing the number of medications, suggesting that physicians should use these measures to attain the recommended lower BP goals If goal BP is not reached, referral to a clinical hypertension specialist may be appropriate.</description><subject>Adult</subject><subject>Aged</subject><subject>Antihypertensive Agents - administration & dosage</subject><subject>Arterial hypertension. Arterial hypotension</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Blood Pressure - drug effects</subject><subject>Cardiology. Vascular system</subject><subject>Clinical manifestations. Epidemiology. Investigative techniques. Etiology</subject><subject>Cohort Studies</subject><subject>Drug Resistance</subject><subject>drug therapy/combination</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Hemodynamics. Rheology</subject><subject>Humans</subject><subject>hypertension</subject><subject>Hypertension - drug therapy</subject><subject>Male</subject><subject>Medical sciences</subject><subject>MESH headings: antihypertensive agents/therapeutic use</subject><subject>Middle Aged</subject><subject>Patient Compliance</subject><subject>Vertebrates: cardiovascular system</subject><issn>0895-7061</issn><issn>1879-1905</issn><issn>1941-7225</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqN0V2r0zAYB_Aiimce_QrHguhda9I2b155HOqEwxHHjoxzE7LkKUtdm5q00317MzodeKNXgfB7Xvg_SXKFUY4Rpq-bXLXN9tCDzwuEqhzjHBX4QTLDnIkMC0QeJjPEBckYovgieRJCgyKkFD9OLjDhvCBVNUtulxBsGFQ3pItjtwG6YF2XLmFvgx3AvEmv07lre-VtiP-uTlc_XHrX2T34CA7ZOxXARLJ1fghPk0e12gV4dnovk7sP71fzRXbz-eOn-fVNpgmjQ2Y4Mxq0qgzXNUWmroFTArTCjGDDqeYEuCG1poLWpCiNwKXebAjRXJS8JuVl8mrq23v3fYQwyNYGDbud6sCNQVLGES9wGeGLv2DjRt_F3SRGBSUUV4JFRSelvQvBQy17b1vlDxHJY96ykb_zlse8JcYy5h0Lr07tx00L5lx2CjiClyeggla72qtO23B2lDGB2NHhybmx___hz6eaTg2jhz9lqtlGRoSIIptEPDH8PAP_LSZUMiIX63t5-3Up1uv7lfwS_dvJQ7zd3sZ5QVvoNBjrQQ_SOPuvpX4BZhLMNA</recordid><startdate>20050501</startdate><enddate>20050501</enddate><creator>Garg, Jay P.</creator><creator>Elliott, William J.</creator><creator>Folker, Amy</creator><creator>Izhar, Munavvar</creator><creator>Black, Henry R.</creator><general>Elsevier Inc</general><general>Oxford University Press</general><general>Elsevier Science</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20050501</creationdate><title>Resistant Hypertension Revisited: A Comparison of Two University-Based Cohorts</title><author>Garg, Jay P. ; Elliott, William J. ; Folker, Amy ; Izhar, Munavvar ; Black, Henry R.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c576t-d87dceca4d8cf60dffe865e641751d86c85e8d5fc696f523d913cbb55c8938f53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Antihypertensive Agents - administration & dosage</topic><topic>Arterial hypertension. Arterial hypotension</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Blood Pressure - drug effects</topic><topic>Cardiology. Vascular system</topic><topic>Clinical manifestations. Epidemiology. Investigative techniques. Etiology</topic><topic>Cohort Studies</topic><topic>Drug Resistance</topic><topic>drug therapy/combination</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Hemodynamics. Rheology</topic><topic>Humans</topic><topic>hypertension</topic><topic>Hypertension - drug therapy</topic><topic>Male</topic><topic>Medical sciences</topic><topic>MESH headings: antihypertensive agents/therapeutic use</topic><topic>Middle Aged</topic><topic>Patient Compliance</topic><topic>Vertebrates: cardiovascular system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Garg, Jay P.</creatorcontrib><creatorcontrib>Elliott, William J.</creatorcontrib><creatorcontrib>Folker, Amy</creatorcontrib><creatorcontrib>Izhar, Munavvar</creatorcontrib><creatorcontrib>Black, Henry R.</creatorcontrib><creatorcontrib>RUSH University Hypertension Service</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of hypertension</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Garg, Jay P.</au><au>Elliott, William J.</au><au>Folker, Amy</au><au>Izhar, Munavvar</au><au>Black, Henry R.</au><aucorp>RUSH University Hypertension Service</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Resistant Hypertension Revisited: A Comparison of Two University-Based Cohorts</atitle><jtitle>American journal of hypertension</jtitle><addtitle>AJH</addtitle><date>2005-05-01</date><risdate>2005</risdate><volume>18</volume><issue>5</issue><spage>619</spage><epage>626</epage><pages>619-626</pages><issn>0895-7061</issn><eissn>1879-1905</eissn><eissn>1941-7225</eissn><coden>AJHYE6</coden><abstract>More than a decade ago, we found that a suboptimal medication regimen was the leading cause of resistant hypertension (RH) among patients referred to a tertiary care clinic. Since then, lower blood pressure (BP) goals have been recommended, suggesting that more patients may have RH. To assess whether the reasons for and treatment of RH have changed, we determined the frequency of various causes of resistance, the proportion of patients achieving goal BP, and the changes made in antihypertensive regimens.
The charts of all new patients seen at the RUSH University Hypertension Center between January 1, 1993, and November 1, 2001, were reviewed for strict criteria for RH: 1) physician referral for uncontrolled hypertension; 2) BP ≥140/90 mm Hg despite use of three antihypertensive drugs; and 3) at least one follow-up visit. Patients were followed-up until goal BP was achieved on two consecutive visits or their last visit or until March 2002.
Of 1281 patients, 141 met criteria for RH. A cause of resistance was found in 94% of cases, including the following: drug-related causes (58%); nonadherence (16%); psychological causes (9%); office resistance (ie, in-clinic BP readings that were higher than goal despite treatment with antihypertensive medications and despite normotensive BP outside of the clinic as demonstrated by 24-h ambulatory BP monitoring) (6%); and secondary hypertension (5%). Overall, 53% of patients had their BP controlled to <140/90 mm Hg, largely from regimen optimization and intensification, proper use of diuretics, and on average 4.1 ± 1 antihypertensive medications (3.7 ± 0.9 on referral).
These data are strikingly similar to those from our previous study of RH, in which a suboptimal medication regimen was the most common reason for resistance. Goal BP was most commonly achieved after optimizing the diuretic regimen and increasing the number of medications, suggesting that physicians should use these measures to attain the recommended lower BP goals If goal BP is not reached, referral to a clinical hypertension specialist may be appropriate.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>15882544</pmid><doi>10.1016/j.amjhyper.2004.11.021</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Antihypertensive Agents - administration & dosage Arterial hypertension. Arterial hypotension Biological and medical sciences Blood and lymphatic vessels Blood Pressure - drug effects Cardiology. Vascular system Clinical manifestations. Epidemiology. Investigative techniques. Etiology Cohort Studies Drug Resistance drug therapy/combination Female Follow-Up Studies Fundamental and applied biological sciences. Psychology Hemodynamics. Rheology Humans hypertension Hypertension - drug therapy Male Medical sciences MESH headings: antihypertensive agents/therapeutic use Middle Aged Patient Compliance Vertebrates: cardiovascular system |
| title | Resistant Hypertension Revisited: A Comparison of Two University-Based Cohorts |
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