title: Psychosocial correlates of apparent treatment-resistant hypertension in the Jackson Heart Study.
abstract: Apparent treatment-resistant hypertension (aTRH) is associated with adverse cardiovascular outcomes. aTRH is common and disproportionately affects African Americans. The objective of this study is to explore psychosocial correlates of aTRH in a population-based cohort of African Americans with hypertension. The sample included 1392 participants in the Jackson Heart Study with treated hypertension who reported being adherent to their antihypertensive medications. aTRH was defined as uncontrolled clinic BP (⩾140/90 mm Hg) with ⩾3 classes of antihypertensive medication or treatment with ⩾4 classes of antihypertensive medication, including a diuretic. Self-reported medication adherence was defined as taking all prescribed antihypertensive medication in the 24 h before the study visit. The association of psychosocial factors (chronic stress, depressive symptoms, perceived social support and social network) with aTRH was evaluated using Poisson regression with progressive adjustment for demographic, clinical and behavioural factors. The prevalence of aTRH was 15.1% (n=210). Participants with aTRH had lower social network scores (that is, fewer sources of regular social contact) compared with participants without aTRH (P<0.01). No other psychosocial factors differed between groups. Social network was also the only psychosocial factor that was associated with aTRH prevalence in regression analyses. In age-, sex-adjusted and fully adjusted models, one additional unique source of social contact was associated with a 19% (PR=0.81; 95% confidence interval (CI): 0.68-0.94, P=0.001) and a 13% (PR=0.87; 95% CI 0.74-1.0, P=0.041) lower prevalence of aTRH, respectively. Social network was independently associated with aTRH and warrants further investigation as a potentially modifiable determinant of aTRH in African Americans.
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, NY, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Shallcross
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, NY, USA.
authors.forename: M
authors.initials: M
authors.lastname: Butler
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: R M
authors.initials: RM
authors.lastname: Tanner
authors.affiliation: Department of Pharmacotherapy, University of Utah, Salt Lake City, UT, USA.
authors.forename: A P
authors.initials: AP
authors.lastname: Bress
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: P
authors.initials: P
authors.lastname: Muntner
authors.affiliation: Department of Medicine, Columbia University Medical Center, New York, NY, USA.
authors.forename: D
authors.initials: D
authors.lastname: Shimbo
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, NY, USA.
authors.forename: G
authors.initials: G
authors.lastname: Ogedegbe
authors.affiliation: Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: M
authors.initials: M
authors.lastname: Sims
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, NY, USA.
authors.forename: T M
authors.initials: TM
authors.lastname: Spruill
mesh_terms: D001741:Black or African American / Q000523:psychology; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D012944:Social Support; D017211:Treatment Failure
chemical_list: D000959:Antihypertensive Agents