title: Prevalence of treatment-resistant hypertension and important associated factors-results from the Swedish Primary Care Cardiovascular Database.
abstract: We aimed to describe the prevalence, treatment, and associated comorbidity of treatment-resistant hypertension (TRH). This registry-based cohort study from The Swedish Primary Care Cardiovascular Database assessed 53,090 hypertensive patients attending primary care. Patients adherent to antihypertensive treatment measured by pharmacy fills and with proportion of days covered ≥80% were included. The prevalence of TRH was 17% when considering all current TRH definitions. Adherence to mineralocorticoid receptor antagonists differed between TRH- and non-TRH patients (8 vs. 4%). Higher frequencies (prevalence ratio and 95% confidence intervals) of diabetes mellitus (1.59, 1.53-1.66), heart failure (1.55, 1.48-1.64), atrial fibrillation (1.33, 1.27-1.40), ischemic heart disease (1.25, 1.20-1.30), and chronic kidney disease (1.38, 1.23-1.54) were seen in patients with TRH compared to patients without TRH. These findings, in a population with valid data on medication adherence, emphasize a broad preventive approach for these high-risk patients.
authors.affiliation: Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden. Electronic address: lina.holmqvist@vgregion.se.
authors.forename: Lina
authors.initials: L
authors.lastname: Holmqvist
authors.affiliation: R & D Centre Skaraborg Primary Care, Skövde, Sweden.
authors.forename: Kristina Bengtsson
authors.initials: KB
authors.lastname: Boström
authors.affiliation: Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kahan
authors.affiliation: Department of Occupational and Enviromental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
authors.forename: Linus
authors.initials: L
authors.lastname: Schiöler
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Centre for Family Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Hasselström
authors.affiliation: R & D Centre Skaraborg Primary Care, Skövde, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Hjerpe
authors.affiliation: Department of Medicine, Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden; Public Healthcare Services Committee, Stockholm County Council, Stockholm, Sweden.
authors.forename: Björn
authors.initials: B
authors.lastname: Wettermark
authors.affiliation: Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Manhem
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D003329:Coronary Vasospasm / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D017202:Myocardial Ischemia / Q000453:epidemiology*; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D016903:Drug Monitoring
chemical_list: D000959:Antihypertensive Agents; D000451:Mineralocorticoid Receptor Antagonists
keywords: Drug treatment; mineralocorticoid receptor antagonist; primary health care; treatment resistant hypertension