Prevalence of treatment-resistant hypertension and important associated factors—results from the Swedish Primary Care Cardiovascular Database

Holmqvist, Lina; Boström, Kristina Bengtsson; Kahan, Thomas; Schiöler, Linus; Hasselström, Jan; Hjerpe, Per; Wettermark, Björn; Manhem, Karin

doi:10.1016/j.jash.2016.08.008

Cited by 19 publications

(30 citation statements)

References 38 publications

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“…On multivariate regression analysis, patients with true RH in the current study were more likely to be black, and to have a higher mean BMI, medical history of DM requiring insulin, HFpEF, and CKD stage 3 or higher (Table ). These findings are consistent with those of prior studies conducted on RH subjects across all ranges of BMI values . DM and insulin resistance are associated with true RH, and this association is further amplified when DM is complicated with microvascular disease .…”

Section: Discussionsupporting

confidence: 91%

“…This reflected on those with DM requiring insulin in the current study, which indicated more severe DM. HFpEF showed strong association with true RH in the current study as seen in other studies mostly due to increased afterload . Subjects with true RH were more likely to have CKD stage 3 or above in our study.…”

Section: Discussionsupporting

confidence: 85%

“…HFpEF showed strong association with true RH in the current study as seen in other studies mostly due to increased afterload. 25,27,30 Subjects with true RH were more likely to have CKD stage 3 or above in our study. The relationship between CKD and uncontrolled BP is bidirectional and is related to an alteration in the renal vasculature which is further amplified in subjects with obesity contributing to a pathological vicious cycle.…”

Section: Discussionmentioning

confidence: 60%

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The prevalence and predictors of resistant hypertension in high‐risk overweight and obese patients: A cross‐sectional study based on the 2017 ACC/AHA guidelines

Haddadin

Sud

Estrella

et al. 2019

J of Clinical Hypertension

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Obesity is significantly associated with uncontrolled blood pressure and resistant hypertension (RH). There are limited studies on the prevalence and determinants of RH in patients with higher body mass index (BMI) values. Since the hypertension guidelines changed in 2017, the prevalence of RH has become unknown and now is subject to be estimated by further studies. We conducted a cross‐sectional study in an urban Federally Qualified Health Center in New York City aiming to estimate the prevalence of RH in high‐risk overweight and obese patients based on the new hypertension definition, BP threshold ≥130/80 mm Hg, and also to describe the associated comorbid conditions in these patients. We identified 761 eligible high‐risk overweight and obese subjects with hypertension between October 2017 and October 2018. Apparent treatment‐RH was found in 13.6% among the entire study population. This represented 15.4% of those treated with BP‐lowering agents. True RH confirmed with out‐of‐office elevated BP was found in 6.7% of the study population and 7.4% among patients treated with BP‐lowering agents. Prevalence was higher with higher BMI values. Those with true RH were more likely to be black, to have diabetes mellitus requiring insulin, chronic kidney disease stage 3 or above and diastolic heart failure. In conclusion, obesity is significantly associated with RH and other significant metabolic comorbid conditions.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 60%

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The prevalence and predictors of resistant hypertension in high‐risk overweight and obese patients: A cross‐sectional study based on the 2017 ACC/AHA guidelines

Haddadin

Sud

Estrella

et al. 2019

J of Clinical Hypertension

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“…Regarding the predominance of females, based on the ALLHAT study, Cushman et al 28 controlling SAH in black women. 28 In a population study carried out in Sweden, Holmqvist et al 31 also reported that women had a higher prevalence of RH, except when they specifically assessed the subgroup with controlled RH. 31 The present finding of a higher proportion of women in our sample of individuals with HR should be interpreted with caution, as it can be overestimated by Brazilian cultural aspects, since women tend to seek more health care.…”

Section: Discussionmentioning

confidence: 99%

Características Clínicas da Hipertensão Arterial Resistente vs. Refratária em uma População de Hipertensos Afrodescendentes

Macedo

Aras

Macêdo

2020

Arquivos Brasileiros De Cardiologia

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Background: Afrodescendants have been associated with a greater severity of arterial hypertension and a higher incidence of cardiovascular complications. Characteristics in the presentation of resistant hypertension (RH) or refractory hypertension (RfH), specifically in this ethnic group, have not been properly studied. Objectives: The study compares clinical and epidemiological characteristics and prevalence of cardiovascular events in people of African descent diagnosed with RH or RfH. Methods: Cross-sectional study carried out in a referral clinic for patients with severe hypertension. The level of significance was 5%. Results: 146 consecutive patients were evaluated, of which 68.7% were female. The average age was 61.8 years, with 88.4% of Afrodescendants (mixed race or black). 51% had RfH. There was a high prevalence of cardiovascular risk factors: 34.2% of subjects had diabetes, 69.4% dyslipidemia, 36.1% obesity, and 38.3% history of smoking. Reduced renal function was seen in 34.2%. Previous cardiovascular events occurred in 21.8% for myocardial infarction and in 19.9% for stroke. The Framingham's risk score was moderate/high at 61%. RfH patients were younger (mean age 59.38±11.69 years versus 64.10±12.23 years, p=0.02), had more dyslipidemia (83.8 versus 66.7%, p=0.021), and stroke (30.4 versus 12.3%, p=0.011) when compared to those with RH. The use of a combination of ACEi/ARB+CCB+Diuretic, chlortalidone and spironolactone was also more frequent in individuals with RfH. Conclusion: Africandescendant people with RH had a high cardiovascular risk, a high prevalence of RfH, a higher frequency of dyslipidemia and stroke, compatible with a high incidence of injury to target organs.

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“…Applying the AHA/ ESC definition, with consideration of adherence only, found a prevalence of 17%. 24 They excluded all patients whose proportion of days with pharmacy refills was <80% as not having TRH. The level of morbidity (for example, diabetes) and type of medication used in this contemporaneous Swedish group is very similar to this one.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Prevalence of treatment-resistant hypertension after considering pseudo-resistance and morbidity: a cross-sectional study in Irish primary care

Hayes¹,

Casey²,

Glynn

et al. 2018

Br J Gen Pract

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Prevalence of treatment-resistant hypertension and important associated factors—results from the Swedish Primary Care Cardiovascular Database

Cited by 19 publications

References 38 publications

The prevalence and predictors of resistant hypertension in high‐risk overweight and obese patients: A cross‐sectional study based on the 2017 ACC/AHA guidelines

The prevalence and predictors of resistant hypertension in high‐risk overweight and obese patients: A cross‐sectional study based on the 2017 ACC/AHA guidelines

Características Clínicas da Hipertensão Arterial Resistente vs. Refratária em uma População de Hipertensos Afrodescendentes

Prevalence of treatment-resistant hypertension after considering pseudo-resistance and morbidity: a cross-sectional study in Irish primary care

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