TY - JOUR
T1 - Results of a retrospective, observational pilot study using electronic medical records to assess the prevalence and characteristics of patients with resistant hypertension in an ambulatory care setting
AU - McAdam-Marx, Carrie
AU - Ye, Xiangyang
AU - Sung, Jennifer C.
AU - Brixner, Diana I.
AU - Kahler, Kristijan H.
N1 - Funding Information:
This study was funded by Novartis Pharmaceuticals Corporation. Brian Oberg, MBA, provided data management support and Joseph Biskupiak, PhD, reviewed early versions of this manuscript; both Mr. Oberg and Dr. Biskupiak are employed by the University of Utah’s Pharmacotherapy Outcomes Research Center.
PY - 2009/5
Y1 - 2009/5
N2 - Background: Resistant hypertension, or failure to attain blood pressure (BP) goals while treated with ≥3 antihypertensives (including a diuretic), occurred in 15% to 18% of patients in prospective cohort trials. Objectives: The aims of this work were to identify the prevalence of resistant hypertension in an ambulatory care setting and to describe the characteristics of patients with resistant hypertension. Methods: Adults with hypertension were retrospectively identified in a US electronic medical record from November 1, 2002, through November 30, 2005. Antihypertensive treatment and BP values were assessed to identify those with BP ≥140/90 mm Hg (>130/80 mm Hg for those with diabetes mellitus or kidney disease). Patients treated with ≥3 agents (including a thiazide) who had ≥1 BP level above target were classified as having resistant hypertension. Baseline characteristics were compared between those with and those without resistant hypertension. Results: Of 29,474 study patients aged ≥18 years, 21,460 (72.8%) had ≥1 prescription order for an antihypertensive and 19,202 (65.1%) had a follow-up BP level above target. The analysis found that 2670 patients (9.1% overall or 12.4% of those who were treated) were classified as having resistant hypertension. Relative to those without resistant hypertension, a greater proportion of those with resistant hypertension were female (65.6% vs 60.5%), were older (66.2 vs 63.0 years), had a higher body mass index (31.6 vs 30.4 kg/m2), had higher baseline BP levels (148/81 vs 138/80 mm Hg), and had higher rates of diabetes mel-litus (35.2% vs 20.1%) or kidney disease (4.9% vs 2.7%) than those without resistant hypertension (all comparisons, P < 0.001). Conclusions: This retrospective, observational pilot study of usual community practice supports the findings from prospective trials that resistant hypertension is an important clinical problem. More effective management is needed to enable patients with, or at risk for, resistant hypertension to achieve BP goals.
AB - Background: Resistant hypertension, or failure to attain blood pressure (BP) goals while treated with ≥3 antihypertensives (including a diuretic), occurred in 15% to 18% of patients in prospective cohort trials. Objectives: The aims of this work were to identify the prevalence of resistant hypertension in an ambulatory care setting and to describe the characteristics of patients with resistant hypertension. Methods: Adults with hypertension were retrospectively identified in a US electronic medical record from November 1, 2002, through November 30, 2005. Antihypertensive treatment and BP values were assessed to identify those with BP ≥140/90 mm Hg (>130/80 mm Hg for those with diabetes mellitus or kidney disease). Patients treated with ≥3 agents (including a thiazide) who had ≥1 BP level above target were classified as having resistant hypertension. Baseline characteristics were compared between those with and those without resistant hypertension. Results: Of 29,474 study patients aged ≥18 years, 21,460 (72.8%) had ≥1 prescription order for an antihypertensive and 19,202 (65.1%) had a follow-up BP level above target. The analysis found that 2670 patients (9.1% overall or 12.4% of those who were treated) were classified as having resistant hypertension. Relative to those without resistant hypertension, a greater proportion of those with resistant hypertension were female (65.6% vs 60.5%), were older (66.2 vs 63.0 years), had a higher body mass index (31.6 vs 30.4 kg/m2), had higher baseline BP levels (148/81 vs 138/80 mm Hg), and had higher rates of diabetes mel-litus (35.2% vs 20.1%) or kidney disease (4.9% vs 2.7%) than those without resistant hypertension (all comparisons, P < 0.001). Conclusions: This retrospective, observational pilot study of usual community practice supports the findings from prospective trials that resistant hypertension is an important clinical problem. More effective management is needed to enable patients with, or at risk for, resistant hypertension to achieve BP goals.
KW - ambulatory care
KW - blood pressure
KW - community practice
KW - resistant hypertension
UR - http://www.scopus.com/inward/record.url?scp=66949115332&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=66949115332&partnerID=8YFLogxK
U2 - 10.1016/j.clinthera.2009.05.007
DO - 10.1016/j.clinthera.2009.05.007
M3 - Article
C2 - 19539112
AN - SCOPUS:66949115332
SN - 0149-2918
VL - 31
SP - 1116
EP - 1123
JO - Clinical Therapeutics
JF - Clinical Therapeutics
IS - 5
ER -