title: Prevalence and factors associated with resistant hypertension in a large health maintenance organization in Israel.
abstract: Previous assessments of the prevalence of resistant hypertension (RH) in uncontrolled blood pressure (BP) have ranged from 3% to 30%. Using real-world data, our aim was to estimate the prevalence of RH in patients belonging to the Maccabi Healthcare Services, a 2-million-member health organization in Israel. From 2010 to 2011, all hypertensive patients with ≥2 recorded BP measurements during a minimum period of 6 months were identified. Patients were considered uncontrolled if their most recent BP during the study period and their mean systolic BP or diastolic BP during a preceding period of ≥6months were systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg, or systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg in chronic kidney disease or diabetes mellitus. Uncontrolled patients taking diuretics and ≥2 antihypertensive therapy classes at their maximal recommended dose were regarded as resistant hypertensives. A total of 172 432 patients were eligible for the study. Uncontrolled BP was found in 35.9% (n=65 710). Overall, 2.2% of the uncontrolled patients (n=1487) were resistant hypertensives. Patients with RH were characterized by a significantly (P<0.01) older age, higher body mass index, and multicomorbidity (including dyslipidemia, diabetes mellitus, and impaired renal function) compared with patients with controlled hypertension receiving equivalent treatment. The results of this large population-based study indicate a substantially lower prevalence of RH than previously reported. Most patients with uncontrolled BP took less than the maximal recommended antihypertensive treatment.
authors: From the Primary Care Division, Maccabi Healthcare Services, Tel Aviv, Israel (D.W., G.C., V.S.); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (G.C., V.S., C.G., E.G.); and Rheumatology Unit (C.G.) and Internal Medicine D and Hypertension Unit (E.H.), The Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors: Dahlia
authors: D
authors: Weitzman
authors: From the Primary Care Division, Maccabi Healthcare Services, Tel Aviv, Israel (D.W., G.C., V.S.); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (G.C., V.S., C.G., E.G.); and Rheumatology Unit (C.G.) and Internal Medicine D and Hypertension Unit (E.H.), The Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors: Gabriel
authors: G
authors: Chodick
authors: From the Primary Care Division, Maccabi Healthcare Services, Tel Aviv, Israel (D.W., G.C., V.S.); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (G.C., V.S., C.G., E.G.); and Rheumatology Unit (C.G.) and Internal Medicine D and Hypertension Unit (E.H.), The Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors: Varda
authors: V
authors: Shalev
authors: From the Primary Care Division, Maccabi Healthcare Services, Tel Aviv, Israel (D.W., G.C., V.S.); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (G.C., V.S., C.G., E.G.); and Rheumatology Unit (C.G.) and Internal Medicine D and Hypertension Unit (E.H.), The Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors: Chagai
authors: C
authors: Grossman
authors: From the Primary Care Division, Maccabi Healthcare Services, Tel Aviv, Israel (D.W., G.C., V.S.); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (G.C., V.S., C.G., E.G.); and Rheumatology Unit (C.G.) and Internal Medicine D and Hypertension Unit (E.H.), The Chaim Sheba Medical Center, Tel Hashomer, Israel. grosse@post.tau.ac.il.
authors: Ehud
authors: E
authors: Grossman
mesh_terms: D000367:Age Factors; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D004351:Drug Resistance; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology* / Q000503:physiopathology; D007557:Israel / Q000453:epidemiology; D007674:Kidney Diseases / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies
chemical_list: D000959:Antihypertensive Agents
keywords: diagnosis; epidemiology; hypertension; obesity; pharmaceutical preparations