title: The contributions of unhealthy lifestyle factors to apparent resistant hypertension:  findings from the Reasons for Geographic And Racial Differences in Stroke (REGARDS) study.
abstract: OBJECTIVE
  Unhealthy lifestyle factors may contribute to apparent treatment resistant hypertension (aTRH). We examined associations of unhealthy lifestyle factors with aTRH in individuals taking antihypertensive medications from three or more classes.
  
  
  METHODS
  Participants (n = 2602) taking three or more antihypertensive medication classes were identified from the population-based REasons for Geographic And Racial Differences in Stroke (REGARDS) study. aTRH was defined as having SBP/DBP at least 140/90 mmHg despite the use of three or more antihypertensive medication classes or the use of four or more classes to achieve blood pressure control. Lifestyle factors included obesity, physical inactivity, current smoking, heavy alcohol consumption, a low Dietary Approaches to Stop Hypertension (DASH) diet score and high sodium-to-potassium (Na/K) intake.
  
  
  RESULTS
  Among participants taking three or more antihypertensive medication classes, 1293 (49.7%) participants had aTRH. The prevalence of unhealthy lifestyle factors in participants with and without aTRH was 55.2 and 51.7%, respectively, for obesity, 42.2 and 40.5% for physical inactivity, 11.3 and 11.5% for current smoking, 3.1 and 4.0% for heavy alcohol consumption, 23.1 and 21.5% for low-DASH diet score, and 25.4 and 24.4% for high Na/K intake. After adjustment for age, sex, race, and geographic region of residence, none of the unhealthy lifestyle factors were associated with aTRH. The associations between each unhealthy lifestyle factor and aTRH remained nonsignificant after additional adjustment for education, income, depressive symptoms, total calorie intake, and comorbidities.
  
  
  CONCLUSIONS
  Unhealthy lifestyle factors did not have independent associations with aTRH among individuals taking three or more antihypertensive medication classes.
authors.affiliation: Department of Medicine, Columbia University Medical Center, New York, New York 10032, USA. ds2231@columbia.edu
authors.forename: Daichi
authors.initials: D
authors.lastname: Shimbo
authors.forename: Emily B
authors.initials: EB
authors.lastname: Levitan
authors.forename: John N
authors.initials: JN
authors.lastname: Booth
authors.forename: David A
authors.initials: DA
authors.lastname: Calhoun
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Judd
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Lackland
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
authors.forename: Suzanne
authors.initials: S
authors.lastname: Oparil
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
mesh_terms: D000368:Aged; D005260:Female; D005843:Geography; D015438:Health Behavior; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000208:ethnology / Q000503:physiopathology; D008019:Life Style; D008297:Male; D008875:Middle Aged; D044382:Population Groups