PDF(Pubmed)
Abstract：
Apparent resistant hypertension (aRH) carries excess cardiovascular risk beyond nonresistant forms of hypertension; however, our understanding of this at-risk population, as defined by current US practice guidelines, is limited. Accordingly, we sought to evaluate the prevalence, clinical characteristics, and pharmacotherapeutic patterns of patients with aRH using contemporary blood pressure guidance.
We classified patients at 3 large healthcare systems by hypertensive status using contemporary hypertension guidelines. We subsequently described the demographic and clinical characteristics of patients with aRH and compared these factors among hypertensive patients without aRH and between those with controlled and uncontrolled aRH.
A total of 2 420 468 patients were analyzed, of whom 1 343 489 (55.6%) were hypertensive according to contemporary guidelines. Among hypertensive patients, 11 992 (8.5%) met criteria for aRH, with nearly all assessed comorbid conditions, particularly diabetes and heart failure, being more common in those with aRH. When compared with patients with uncontrolled aRH, those with controlled aRH were more frequently prescribed a beta-blocker, diuretic, and nitrate, with the largest standardized difference observed for a mineralocorticoid receptor antagonist (35.4% versus 10.4%, Cohen D 0.62). Consistent findings were noted in sensitivity analyses using the blood pressure threshold of 140/90 mm Hg.
In an analysis of over 2.4 million individuals, a lower prevalence of aRH was observed than previously reported (12%-15%), but with a high burden of comorbidities. Identification of differences in pharmacotherapy between patients with controlled and uncontrolled aRH, particularly lower rates of mineralocorticoid receptor antagonist use, help define potential opportunities to improve care and lower cardiovascular risk.
We classified patients at 3 large healthcare systems by hypertensive status using contemporary hypertension guidelines. We subsequently described the demographic and clinical characteristics of patients with aRH and compared these factors among hypertensive patients without aRH and between those with controlled and uncontrolled aRH.
A total of 2 420 468 patients were analyzed, of whom 1 343 489 (55.6%) were hypertensive according to contemporary guidelines. Among hypertensive patients, 11 992 (8.5%) met criteria for aRH, with nearly all assessed comorbid conditions, particularly diabetes and heart failure, being more common in those with aRH. When compared with patients with uncontrolled aRH, those with controlled aRH were more frequently prescribed a beta-blocker, diuretic, and nitrate, with the largest standardized difference observed for a mineralocorticoid receptor antagonist (35.4% versus 10.4%, Cohen D 0.62). Consistent findings were noted in sensitivity analyses using the blood pressure threshold of 140/90 mm Hg.
In an analysis of over 2.4 million individuals, a lower prevalence of aRH was observed than previously reported (12%-15%), but with a high burden of comorbidities. Identification of differences in pharmacotherapy between patients with controlled and uncontrolled aRH, particularly lower rates of mineralocorticoid receptor antagonist use, help define potential opportunities to improve care and lower cardiovascular risk.
摘要：
背景：表观抵抗性高血压（aRH）具有超出非抵抗性高血压形式的额外心血管风险；然而，我们对这个高危人群的理解，根据当前美国实践指南的定义，是有限的。因此，我们试图评估患病率，临床特征,和使用当代血压指导的aRH患者的药物治疗模式。
方法：我们使用当代高血压指南按高血压状态对3个大型医疗系统的患者进行分类。随后，我们描述了aRH患者的人口统计学和临床特征，并比较了无aRH的高血压患者以及aRH受控和不受控的高血压患者之间的这些因素。
结果：共分析了2420468例患者，根据当代指南，其中1343489（55.6％）为高血压。在高血压患者中，11992（8.5%）符合aRH标准，在几乎所有评估的共病条件下，尤其是糖尿病和心力衰竭，在ARH患者中更为常见。与aRH未受控制的患者相比，那些控制aRH的人更频繁地开了β受体阻滞剂，利尿剂,还有硝酸盐,盐皮质激素受体拮抗剂的标准化差异最大（35.4%对10.4%，科恩D0.62）。在使用140/90mmHg的血压阈值的敏感性分析中注意到一致的发现。
结论：在对超过240万人的分析中，观察到aRH的患病率低于以前报道的（12％-15％），但是有很高的合并症负担。确定控制和不控制的aRH患者之间的药物治疗差异，盐皮质激素受体拮抗剂使用率特别低，帮助确定改善护理和降低心血管风险的潜在机会。
方法：我们使用当代高血压指南按高血压状态对3个大型医疗系统的患者进行分类。随后，我们描述了aRH患者的人口统计学和临床特征，并比较了无aRH的高血压患者以及aRH受控和不受控的高血压患者之间的这些因素。
结果：共分析了2420468例患者，根据当代指南，其中1343489（55.6％）为高血压。在高血压患者中，11992（8.5%）符合aRH标准，在几乎所有评估的共病条件下，尤其是糖尿病和心力衰竭，在ARH患者中更为常见。与aRH未受控制的患者相比，那些控制aRH的人更频繁地开了β受体阻滞剂，利尿剂,还有硝酸盐,盐皮质激素受体拮抗剂的标准化差异最大（35.4%对10.4%，科恩D0.62）。在使用140/90mmHg的血压阈值的敏感性分析中注意到一致的发现。
结论：在对超过240万人的分析中，观察到aRH的患病率低于以前报道的（12％-15％），但是有很高的合并症负担。确定控制和不控制的aRH患者之间的药物治疗差异，盐皮质激素受体拮抗剂使用率特别低，帮助确定改善护理和降低心血管风险的潜在机会。
