Refractory Hypertension: Determination of Prevalence, Risk Factors, and Comorbidities in a Large, Population-Based Cohort
Refractory hypertension is an extreme phenotype of antihypertensive treatment failure. Participants in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study, a large (n=30 239), population-based cohort were evaluated to determine the prevalence of refractory hypertension and as...
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| Veröffentlicht in: | Hypertension (Dallas, Tex. 1979) Tex. 1979), 2014-03, Vol.63 (3), p.451-458 |
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| container_title | Hypertension (Dallas, Tex. 1979) |
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| creator | Calhoun, David A. Booth, John N. Oparil, Suzanne Irvin, Marguerite R. Shimbo, Daichi Lackland, Daniel T. Howard, George Safford, Monika M. Muntner, Paul |
| description | Refractory hypertension is an extreme phenotype of antihypertensive treatment failure. Participants in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study, a large (n=30 239), population-based cohort were evaluated to determine the prevalence of refractory hypertension and associated cardiovascular risk factors and comorbidities. Refractory hypertension was defined as uncontrolled blood pressure (systolic/diastolic, ≥140/90 mm Hg) on ≥5 antihypertensive drug classes. Participants with resistant hypertension (systolic/diastolic, ≥140/90 mm Hg on ≥3 or |
| doi_str_mv | 10.1161/HYPERTENSIONAHA.113.02026 |
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Participants in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study, a large (n=30 239), population-based cohort were evaluated to determine the prevalence of refractory hypertension and associated cardiovascular risk factors and comorbidities. Refractory hypertension was defined as uncontrolled blood pressure (systolic/diastolic, ≥140/90 mm Hg) on ≥5 antihypertensive drug classes. Participants with resistant hypertension (systolic/diastolic, ≥140/90 mm Hg on ≥3 or <140/90 mm Hg on ≥4 antihypertensive classes) and all participants treated for hypertension served as comparator groups. Of 14 809 REGARDS participants receiving antihypertensive treatment, 78 (0.5%) had refractory hypertension. The prevalence of refractory hypertension was 3.6% among participants with resistant hypertension (n=2144) and 41.7% among participants on ≥5 antihypertensive drug classes. Among all participants with hypertension, black race, male sex, living in the stroke belt or buckle, higher body mass index, lower heart rate, reduced estimated glomerular filtration rate, albuminuria, diabetes mellitus, and history of stroke and coronary heart disease were associated with refractory hypertension. Compared with resistant hypertension, prevalence ratios for refractory hypertension were increased for blacks (3.00; 95% confidence interval, 1.68–5.37) and those with albuminuria (2.22; 95% confidence interval, 1.40–3.52) and diabetes mellitus (2.09; 95% confidence interval, 1.32–3.31). The median 10-year Framingham risk for coronary heart disease and stroke was higher among participants with refractory hypertension when compared with those with either comparator group. These data indicate that although resistant hypertension is relatively common among treated patients with hypertension, true antihypertensive treatment failure is rare.</description><identifier>ISSN: 0194-911X</identifier><identifier>EISSN: 1524-4563</identifier><identifier>DOI: 10.1161/HYPERTENSIONAHA.113.02026</identifier><identifier>PMID: 24324035</identifier><identifier>CODEN: HPRTDN</identifier><language>eng</language><publisher>Hagerstown, MD: American Heart Association, Inc</publisher><subject>Aged ; Antihypertensive Agents - therapeutic use ; Arterial hypertension. Arterial hypotension ; Biological and medical sciences ; Blood and lymphatic vessels ; Blood Pressure ; Cardiology. Vascular system ; Comorbidity ; Coronary Artery Disease - epidemiology ; Diabetes Mellitus, Type 2 - epidemiology ; Diabetes. Impaired glucose tolerance ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Etiopathogenesis. Screening. Investigations. Target tissue resistance ; Female ; Humans ; Hypertension - drug therapy ; Hypertension - epidemiology ; Hypertension - physiopathology ; Male ; Medical sciences ; Population Surveillance ; Prevalence ; Risk Factors ; Stroke - epidemiology ; Treatment Failure ; United States - epidemiology</subject><ispartof>Hypertension (Dallas, Tex. 1979), 2014-03, Vol.63 (3), p.451-458</ispartof><rights>2014 American Heart Association, Inc</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3306-3faf5b1354c369d1fa572ff81c2af5d736872f8dd41e0932a2e032cb2692eddb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,3674,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28259776$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24324035$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Calhoun, David A.</creatorcontrib><creatorcontrib>Booth, John N.</creatorcontrib><creatorcontrib>Oparil, Suzanne</creatorcontrib><creatorcontrib>Irvin, Marguerite R.</creatorcontrib><creatorcontrib>Shimbo, Daichi</creatorcontrib><creatorcontrib>Lackland, Daniel T.</creatorcontrib><creatorcontrib>Howard, George</creatorcontrib><creatorcontrib>Safford, Monika M.</creatorcontrib><creatorcontrib>Muntner, Paul</creatorcontrib><title>Refractory Hypertension: Determination of Prevalence, Risk Factors, and Comorbidities in a Large, Population-Based Cohort</title><title>Hypertension (Dallas, Tex. 1979)</title><addtitle>Hypertension</addtitle><description>Refractory hypertension is an extreme phenotype of antihypertensive treatment failure. Participants in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study, a large (n=30 239), population-based cohort were evaluated to determine the prevalence of refractory hypertension and associated cardiovascular risk factors and comorbidities. Refractory hypertension was defined as uncontrolled blood pressure (systolic/diastolic, ≥140/90 mm Hg) on ≥5 antihypertensive drug classes. Participants with resistant hypertension (systolic/diastolic, ≥140/90 mm Hg on ≥3 or <140/90 mm Hg on ≥4 antihypertensive classes) and all participants treated for hypertension served as comparator groups. Of 14 809 REGARDS participants receiving antihypertensive treatment, 78 (0.5%) had refractory hypertension. The prevalence of refractory hypertension was 3.6% among participants with resistant hypertension (n=2144) and 41.7% among participants on ≥5 antihypertensive drug classes. Among all participants with hypertension, black race, male sex, living in the stroke belt or buckle, higher body mass index, lower heart rate, reduced estimated glomerular filtration rate, albuminuria, diabetes mellitus, and history of stroke and coronary heart disease were associated with refractory hypertension. Compared with resistant hypertension, prevalence ratios for refractory hypertension were increased for blacks (3.00; 95% confidence interval, 1.68–5.37) and those with albuminuria (2.22; 95% confidence interval, 1.40–3.52) and diabetes mellitus (2.09; 95% confidence interval, 1.32–3.31). The median 10-year Framingham risk for coronary heart disease and stroke was higher among participants with refractory hypertension when compared with those with either comparator group. These data indicate that although resistant hypertension is relatively common among treated patients with hypertension, true antihypertensive treatment failure is rare.</description><subject>Aged</subject><subject>Antihypertensive Agents - therapeutic use</subject><subject>Arterial hypertension. Arterial hypotension</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Blood Pressure</subject><subject>Cardiology. Vascular system</subject><subject>Comorbidity</subject><subject>Coronary Artery Disease - epidemiology</subject><subject>Diabetes Mellitus, Type 2 - epidemiology</subject><subject>Diabetes. Impaired glucose tolerance</subject><subject>Endocrine pancreas. Apud cells (diseases)</subject><subject>Endocrinopathies</subject><subject>Etiopathogenesis. Screening. Investigations. Target tissue resistance</subject><subject>Female</subject><subject>Humans</subject><subject>Hypertension - drug therapy</subject><subject>Hypertension - epidemiology</subject><subject>Hypertension - physiopathology</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Population Surveillance</subject><subject>Prevalence</subject><subject>Risk Factors</subject><subject>Stroke - epidemiology</subject><subject>Treatment Failure</subject><subject>United States - epidemiology</subject><issn>0194-911X</issn><issn>1524-4563</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkc1uEzEUhS0EoqHwCsgs2HWK_8aTQaJSCCmpFLVRKBKsLI99pzGd2JE9aZW3x0lK-Vmxsq7vd44tfQi9oeSUUknfTb_PJ4vryeWXi6vL0XSUL_kpYYTJJ2hASyYKUUr-FA0IrUVRU_rtCL1I6QchVAhRPUdHTHAmCC8HaLuANmrTh7jF0-0aYg8-ueDf40_QQ1w5r_s84tDieYQ73YE3cIIXLt3i830unWDtLR6HVYiNs653kLDzWOOZjjeZnYf1ptu3FB91gh26DLF_iZ61ukvw6uE8Rl_PJ9fjaTG7-nwxHs0KwzmRBW91WzaUl8JwWVva6rJibTukhuWFrbgc5nloraBAas40A8KZaZisGVjb8GN0duhdb5oVWAO-j7pT6-hWOm5V0E79vfFuqW7CnRJUUClkLqgPBSaGlCK0j1lK1M6H-sdHvuRq7yNnX__5-GPyl4AMvH0AdDK6yy68cek3N2RlXVW7og8H7j502Uu67Tb3ENUSdNcv_-MjPwFEmaxB</recordid><startdate>201403</startdate><enddate>201403</enddate><creator>Calhoun, David A.</creator><creator>Booth, John N.</creator><creator>Oparil, Suzanne</creator><creator>Irvin, Marguerite R.</creator><creator>Shimbo, Daichi</creator><creator>Lackland, Daniel T.</creator><creator>Howard, George</creator><creator>Safford, Monika M.</creator><creator>Muntner, Paul</creator><general>American Heart Association, Inc</general><general>Lippincott Williams & Wilkins</general><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>5PM</scope></search><sort><creationdate>201403</creationdate><title>Refractory Hypertension: Determination of Prevalence, Risk Factors, and Comorbidities in a Large, Population-Based Cohort</title><author>Calhoun, David A. ; Booth, John N. ; Oparil, Suzanne ; Irvin, Marguerite R. ; Shimbo, Daichi ; Lackland, Daniel T. ; Howard, George ; Safford, Monika M. ; Muntner, Paul</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3306-3faf5b1354c369d1fa572ff81c2af5d736872f8dd41e0932a2e032cb2692eddb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Antihypertensive Agents - therapeutic use</topic><topic>Arterial hypertension. Arterial hypotension</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Blood Pressure</topic><topic>Cardiology. Vascular system</topic><topic>Comorbidity</topic><topic>Coronary Artery Disease - epidemiology</topic><topic>Diabetes Mellitus, Type 2 - epidemiology</topic><topic>Diabetes. Impaired glucose tolerance</topic><topic>Endocrine pancreas. Apud cells (diseases)</topic><topic>Endocrinopathies</topic><topic>Etiopathogenesis. Screening. Investigations. Target tissue resistance</topic><topic>Female</topic><topic>Humans</topic><topic>Hypertension - drug therapy</topic><topic>Hypertension - epidemiology</topic><topic>Hypertension - physiopathology</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Population Surveillance</topic><topic>Prevalence</topic><topic>Risk Factors</topic><topic>Stroke - epidemiology</topic><topic>Treatment Failure</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Calhoun, David A.</creatorcontrib><creatorcontrib>Booth, John N.</creatorcontrib><creatorcontrib>Oparil, Suzanne</creatorcontrib><creatorcontrib>Irvin, Marguerite R.</creatorcontrib><creatorcontrib>Shimbo, Daichi</creatorcontrib><creatorcontrib>Lackland, Daniel T.</creatorcontrib><creatorcontrib>Howard, George</creatorcontrib><creatorcontrib>Safford, Monika M.</creatorcontrib><creatorcontrib>Muntner, Paul</creatorcontrib><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>PubMed Central (Full Participant titles)</collection><jtitle>Hypertension (Dallas, Tex. 1979)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Calhoun, David A.</au><au>Booth, John N.</au><au>Oparil, Suzanne</au><au>Irvin, Marguerite R.</au><au>Shimbo, Daichi</au><au>Lackland, Daniel T.</au><au>Howard, George</au><au>Safford, Monika M.</au><au>Muntner, Paul</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Refractory Hypertension: Determination of Prevalence, Risk Factors, and Comorbidities in a Large, Population-Based Cohort</atitle><jtitle>Hypertension (Dallas, Tex. 1979)</jtitle><addtitle>Hypertension</addtitle><date>2014-03</date><risdate>2014</risdate><volume>63</volume><issue>3</issue><spage>451</spage><epage>458</epage><pages>451-458</pages><issn>0194-911X</issn><eissn>1524-4563</eissn><coden>HPRTDN</coden><abstract>Refractory hypertension is an extreme phenotype of antihypertensive treatment failure. Participants in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study, a large (n=30 239), population-based cohort were evaluated to determine the prevalence of refractory hypertension and associated cardiovascular risk factors and comorbidities. Refractory hypertension was defined as uncontrolled blood pressure (systolic/diastolic, ≥140/90 mm Hg) on ≥5 antihypertensive drug classes. Participants with resistant hypertension (systolic/diastolic, ≥140/90 mm Hg on ≥3 or <140/90 mm Hg on ≥4 antihypertensive classes) and all participants treated for hypertension served as comparator groups. Of 14 809 REGARDS participants receiving antihypertensive treatment, 78 (0.5%) had refractory hypertension. The prevalence of refractory hypertension was 3.6% among participants with resistant hypertension (n=2144) and 41.7% among participants on ≥5 antihypertensive drug classes. Among all participants with hypertension, black race, male sex, living in the stroke belt or buckle, higher body mass index, lower heart rate, reduced estimated glomerular filtration rate, albuminuria, diabetes mellitus, and history of stroke and coronary heart disease were associated with refractory hypertension. Compared with resistant hypertension, prevalence ratios for refractory hypertension were increased for blacks (3.00; 95% confidence interval, 1.68–5.37) and those with albuminuria (2.22; 95% confidence interval, 1.40–3.52) and diabetes mellitus (2.09; 95% confidence interval, 1.32–3.31). The median 10-year Framingham risk for coronary heart disease and stroke was higher among participants with refractory hypertension when compared with those with either comparator group. These data indicate that although resistant hypertension is relatively common among treated patients with hypertension, true antihypertensive treatment failure is rare.</abstract><cop>Hagerstown, MD</cop><pub>American Heart Association, Inc</pub><pmid>24324035</pmid><doi>10.1161/HYPERTENSIONAHA.113.02026</doi><tpages>8</tpages></addata></record> |
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| ispartof | Hypertension (Dallas, Tex. 1979), 2014-03, Vol.63 (3), p.451-458 |
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| source | MEDLINE; American Heart Association Journals; EZB-FREE-00999 freely available EZB journals; Journals@Ovid Complete |
| subjects | Aged Antihypertensive Agents - therapeutic use Arterial hypertension. Arterial hypotension Biological and medical sciences Blood and lymphatic vessels Blood Pressure Cardiology. Vascular system Comorbidity Coronary Artery Disease - epidemiology Diabetes Mellitus, Type 2 - epidemiology Diabetes. Impaired glucose tolerance Endocrine pancreas. Apud cells (diseases) Endocrinopathies Etiopathogenesis. Screening. Investigations. Target tissue resistance Female Humans Hypertension - drug therapy Hypertension - epidemiology Hypertension - physiopathology Male Medical sciences Population Surveillance Prevalence Risk Factors Stroke - epidemiology Treatment Failure United States - epidemiology |
| title | Refractory Hypertension: Determination of Prevalence, Risk Factors, and Comorbidities in a Large, Population-Based Cohort |
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