Jafari Eissa, Cooper-DeHoff Rhonda M, Effron Mark B, Hogan William R, McDonough Caitrin W
medRxiv. 2023 May 1:2023.04.28.23289293. doi: 10.1101/2023.04.28.23289293.
Apparent treatment-resistant hypertension (aTRH) is defined as uncontrolled blood pressure (BP) despite using ≥3 antihypertensive classes or controlled BP while using ≥4 antihypertensive classes. Patients with aTRH have a higher risk for adverse cardiovascular outcomes compared to patients with controlled hypertension. Although there have been prior reports on the prevalence, characteristics, and predictors of aTRH, these have been broadly derived from smaller datasets, randomized controlled trials, or closed healthcare systems.
We extracted patients with hypertension defined by ICD 9 and 10 codes during 1/1/2015-12/31/2018, from two large electronic health record databases: the OneFlorida Data Trust (n=223,384) and Research Action for Health Network (REACHnet) (n=175,229). We applied our previously validated aTRH and stable controlled hypertension (HTN) computable phenotype algorithms and performed univariate and multivariate analyses to identify the prevalence, characteristics, and predictors of aTRH in these real-world populations.
The prevalence of aTRH in OneFlorida (16.7%) and REACHnet (11.3%) was similar to prior reports. Both populations had a significantly higher proportion of black patients with aTRH compared to those with stable controlled HTN. aTRH in both populations shared similar significant predictors, including black race, diabetes, heart failure, chronic kidney disease, cardiomegaly, and higher body mass index. In both populations, aTRH was significantly associated with similar comorbidities, when compared with stable controlled HTN.
In two large, diverse real-world populations, we observed similar comorbidities and predictors of aTRH as prior studies. In the future, these results may be used to improve healthcare professionals' understanding of aTRH predictors and associated comorbidities.
Prior studies of apparent treatment resistant hypertension have focused on cohorts from smaller datasets, randomized controlled trials, or closed healthcare systems.We used validated computable phenotype algorithms for apparent treatment resistant hypertension and stable controlled hypertension to identify the prevalence, characteristics, and predictors of apparent treatment resistant hypertension in two large, diverse real-world populations. Large, diverse real-world populations showed a similar prevalence of aTRH, 16.7% in OneFlorida and 11.3% in REACHnet, compared to those observed from other cohorts.Patients classified as apparent treatment resistant hypertension were significantly older and had a higher prevalence of comorbid conditions such as diabetes, dyslipidemia, coronary artery disease, heart failure with preserved ejection fraction, and chronic kidney disease stages 1-3.Within diverse, real-world populations, the strongest predictors for apparent treatment resistant hypertension were black race, higher body mass index, heart failure, chronic kidney disease, and diabetes.
显性治疗抵抗性高血压（aTRH）的定义为，尽管使用了≥3类抗高血压药物但血压仍未得到控制，或者在使用≥4类抗高血压药物时血压得到控制。与血压得到控制的高血压患者相比，aTRH患者发生不良心血管结局的风险更高。尽管此前已有关于aTRH的患病率、特征和预测因素的报告，但这些报告大多来自较小的数据集、随机对照试验或封闭的医疗系统。
我们从两个大型电子健康记录数据库中提取了2015年1月1日至2018年12月31日期间由ICD 9和10编码定义的高血压患者：OneFlorida数据信托库（n = 223,384）和健康研究行动网络（REACHnet）（n = 175,229）。我们应用了我们之前验证过的aTRH和稳定控制高血压（HTN）的可计算表型算法，并进行了单变量和多变量分析，以确定这些真实世界人群中aTRH的患病率、特征和预测因素。
OneFlorida（16.7%）和REACHnet（11.3%）中aTRH的患病率与之前的报告相似。与血压稳定控制的HTN患者相比，这两个人群中患有aTRH的黑人患者比例显著更高。这两个人群中的aTRH具有相似的显著预测因素，包括黑人种族、糖尿病、心力衰竭、慢性肾病、心脏肥大和更高的体重指数。与血压稳定控制的HTN相比，在这两个人群中，aTRH与相似的合并症显著相关。
在两个大型、多样的真实世界人群中，我们观察到aTRH的合并症和预测因素与之前的研究相似。未来，这些结果可用于提高医疗专业人员对aTRH预测因素和相关合并症的理解。
先前关于显性治疗抵抗性高血压的研究主要集中在来自较小数据集、随机对照试验或封闭医疗系统的队列。我们使用经过验证的可计算表型算法来诊断显性治疗抵抗性高血压和稳定控制的高血压，并确定了两个大型、多样的真实世界人群中显性治疗抵抗性高血压的患病率、特征和预测因素。与其他队列观察到的情况相比，大型、多样的真实世界人群中aTRH的患病率相似，OneFlorida为16.7%，REACHnet为11.3%。被归类为显性治疗抵抗性高血压的患者年龄显著更大，并且患有糖尿病、血脂异常、冠状动脉疾病、射血分数保留的心力衰竭和1-3期慢性肾病等合并症的患病率更高。在多样的真实世界人群中
