title: Proceedings from Duke resistant hypertension think tank.
abstract: To identify patients at increased risk for cardiovascular outcomes, apparent treatment resistant hypertension (aTRH) is defined as having a blood pressure (BP) above goal despite the use of ≥3 antihypertensive therapies of different classes at maximally tolerated doses, ideally including a diuretic. In light of growing scientific interest in the treatment of this group, a multistakeholder think tank was convened to discuss the current state of knowledge, improve the care of these patients, and identify appropriate study populations for future observational and randomized trials in the field. Although recent epidemiologic studies in selected populations estimate that the prevalence of aTRH is 10% to 15% of hypertensive patients, further large-scale observational studies will be needed to better elucidate risk factors. To spur the development of therapies for aTRH, the development of an "aTRH" label for pharmacologic and device therapies with a developmental pathway including treatment added to the use of existing therapies is favored. Although demonstration of adequate BP lowering should be sufficient to gain Food and Drug Administration approval for therapies targeting aTRH, assessment of improvement in quality of life and cardiovascular outcomes is also desirable and considered in Centers for Medicare and Medicaid Services coverage decisions. Device trials under the aTRH label will need uniform and consistent processes for defining appropriate patient populations as well as postapproval registries assessing both long-term safety and duration of responses. Finally, patients with aTRH are likely to benefit from evaluation by a hypertension team to assure proper patient identification, diagnostic work-up, and therapeutic management before consideration of advanced or novel therapies to lower BP.
authors.affiliation: Division of Cardiology, Duke University Medical Center, Durham, NC.
authors.forename: Sreekanth
authors.initials: S
authors.lastname: Vemulapalli
authors.affiliation: Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC.
authors.forename: Jamy
authors.initials: J
authors.lastname: Ard
authors.affiliation: Department of Medicine, Hypertensive Diseases Unit, University of Chicago, Pritzker School of Medicine, Chicago, IL.
authors.forename: George L
authors.initials: GL
authors.lastname: Bakris
authors.affiliation: Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.affiliation: Division of Cardiology, Advocate Lutheran General Hospital, Park Ridge, IL.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Brown
authors.affiliation: Section of Preventive Medicine, Veterans Affairs Medical Center-Memphis, Memphis, TN.
authors.forename: William C
authors.initials: WC
authors.lastname: Cushman
authors.affiliation: Tulane Heart and Vascular Institute and Tulane University School of Medicine, New Orleans, LA.
authors.forename: Keith C
authors.initials: KC
authors.lastname: Ferdinand
authors.affiliation: Department of Medicine, Wayne State University, Detroit, MI.
authors.forename: John M
authors.initials: JM
authors.lastname: Flack
authors.affiliation: Division of Cardiovascular Sciences, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD.
authors.forename: Jerome L
authors.initials: JL
authors.lastname: Fleg
authors.affiliation: Baptist Cardiac and Vascular Institute, Miami, FL.
authors.forename: Barry T
authors.initials: BT
authors.lastname: Katzen
authors.affiliation: Department of Medicine, UMDNJ-RWJ Medical School, New Brunswick, NJ.
authors.forename: John B
authors.initials: JB
authors.lastname: Kostis
authors.affiliation: Section of Vascular Biology and Hypertension, University of Alabama-Birmingham, Birmingham, AL.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Oparil
authors.affiliation: Division of Cardiology, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC.
authors.forename: Chet B
authors.initials: CB
authors.lastname: Patel
authors.affiliation: Division of Cardiology, University of Florida, Gainesville, FL.
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Pepine
authors.affiliation: Division of Cardiology, Montefiore Medical Center, New York, NY.
authors.forename: Ileana L
authors.initials: IL
authors.lastname: Piña
authors.affiliation: Prairie Heart Institute at St John's Hospital, Springfield, IL.
authors.forename: Krishna J
authors.initials: KJ
authors.lastname: Rocha-Singh
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Raymond R
authors.initials: RR
authors.lastname: Townsend
authors.affiliation: Division of Cardiology, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: Division of Cardiology, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Califf
authors.affiliation: Division of Cardiology, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC. Electronic address: manesh.patel@duke.edu.
authors.forename: Manesh R
authors.initials: MR
authors.lastname: Patel
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D002339:Carotid Arteries; D002986:Clinical Trials as Topic; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000628:therapy*; D007668:Kidney / Q000294:innervation; D011311:Pressoreceptors; D019736:Prostheses and Implants; D013562:Sympathectomy / Q000295:instrumentation / Q000379:methods*
chemical_list: D000959:Antihypertensive Agents