title: Health-related quality of life in persons with apparent treatment-resistant hypertension on at least four antihypertensives.
abstract: Little is known about the impact of treatment-resistant hypertension (TRH) on health-related quality of life (HrQoL). We aimed to compare HrQoL measures in adults with apparent TRH (aTRH) and non-resistant hypertension among nationally representative US Medical Expenditure Panel Survey data pooled from 2000 to 2011. Cohorts compared were adults with aTRH (⩾2 unique fills from ⩾4 antihypertensive classes during a year) versus non-resistant hypertension (those with hypertension not meeting the aTRH definition). Key outcomes were cohort differences in SF-12v2 physical component summary (PCS) and mental component summary (MCS) scores and disease-state utility using the SF-6D. Of 57 150 adults with hypertension, 2501 (4.4%) met criteria for aTRH. Persons with aTRH, compared with non-resistant hypertension, were older (mean, 68 vs 61 years), had a higher BMI (30.9 vs 29.7 kg m(-)(2)) and were more likely to be Black (20% vs 14%), but less likely to be female (46% vs 54%). Persons with aTRH, compared with non-resistant hypertension, had lower mean PCS scores (35.8 vs 43.2; P<0.0001), and utility (0.68 vs 0.74; P<0.0001), but similar MCS scores (49.1 vs 50.4). In multivariable-adjusted analyses, aTRH was associated with a 2.37 (95% CI 1.71 to 3.02) lower PCS score and 0.02 (95% CI 0.01 to 0.03) lower utility, compared with non-resistant hypertension. In conclusion, aTRH was associated with substantially lower HrQoL in physical functioning and health utility, but not in mental functioning, compared with non-resistant hypertension. The multivariable-adjusted reduction in physical functioning was similar in magnitude to previous observations comparing hypertension with no hypertension.
authors.affiliation: Departments of Pharmacotherapy & Translational Research and Community Health & Family Medicine, Colleges of Pharmacy and Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: N W
authors.initials: NW
authors.lastname: Carris
authors.affiliation: Department of Economics, American University of Armenia,Yerevan, Armenia.|Department of Clinical Pharmacy and Center for Pharmaceutical Outcomes Research, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA.
authors.forename: V
authors.initials: V
authors.lastname: Ghushchyan
authors.affiliation: Department of Clinical Pharmacy and Center for Pharmaceutical Outcomes Research, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Libby
authors.affiliation: Departments of Pharmacotherapy & Translational Research and Community Health & Family Medicine, Colleges of Pharmacy and Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Smith
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology; D017211:Treatment Failure
chemical_list: D000959:Antihypertensive Agents