title: Prevalence of optimal treatment regimens in patients with apparent treatment-resistant hypertension based on office blood pressure in a community-based practice network.
abstract: Hypertensive patients with clinical blood pressure (BP) uncontrolled on ≥3 antihypertensive medications (ie, apparent treatment-resistant hypertension [aTRH]) comprise ≈28% to 30% of all uncontrolled patients in the United States. However, the proportion receiving these medications in optimal doses is unknown; aTRH is used because treatment adherence and measurement artifacts were not available in electronic record data from our >200 community-based clinics Outpatient Quality Improvement Network. This study sought to define the proportion of uncontrolled hypertensives with aTRH on optimal regimens and clinical factors associated with optimal therapy. During 2007-2010, 468 877 hypertensive patients met inclusion criteria. BP <140/<90 mm Hg defined control. Multivariable logistic regression was used to assess variables independently associated with optimal therapy (prescription of diuretic and ≥2 other BP medications at ≥50% of maximum recommended hypertension doses). Among 468 877 hypertensives, 147 635 (31.5%) were uncontrolled; among uncontrolled hypertensives, 44 684 were prescribed ≥3 BP medications (30.3%), of whom 22 189 (15.0%) were prescribed optimal therapy. Clinical factors independently associated with optimal BP therapy included black race (odds ratio, 1.40 [95% confidence interval, 1.32-1.49]), chronic kidney disease (1.31 [1.25-1.38]), diabetes mellitus (1.30 [1.24-1.37]), and coronary heart disease risk equivalent status (1.29 [1.14-1.46]). Clinicians more often prescribe optimal therapy for aTRH when cardiovascular risk is greater and treatment goals lower. Approximately 1 in 7 of all uncontrolled hypertensives and 1 in 2 with uncontrolled aTRH are prescribed ≥3 BP medications in optimal regimens. Prescribing more optimal pharmacotherapy for uncontrolled hypertensives including aTRH, confirmed with out-of-office BP, could improve hypertension control.
authors.affiliation: University of South Carolina School of Medicine, Greenville, Care Coordination Institute, P.O. Box 367, Greenville, SC 29602. began@carecoordinationinstitute.org.
authors.forename: Brent M
authors.initials: BM
authors.lastname: Egan
authors.forename: Yumin
authors.initials: Y
authors.lastname: Zhao
authors.forename: Jiexiang
authors.initials: J
authors.lastname: Li
authors.forename: W Adam
authors.initials: WA
authors.lastname: Brzezinski
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Todoran
authors.forename: Robert D
authors.initials: RD
authors.lastname: Brook
authors.forename: David A
authors.initials: DA
authors.lastname: Calhoun
mesh_terms: D001741:Black or African American; D000368:Aged; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D001795:Blood Pressure Determination; D003153:Community Health Services; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D017211:Treatment Failure; D014481:United States / Q000453:epidemiology
chemical_list: D000959:Antihypertensive Agents
keywords: blood pressure; hypertension; therapy
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