Trends for prevalence and incidence of resistant hypertension: population based cohort study in the UK 1995-2015

Abstract

Objective To estimate the incidence and prevalence of resistant hypertension among a UK population treated for hypertension from 1995 to 2015. Design Cohort study. Setting Electronic health records from the UK Clinical Practice Research Datalink in primary care. Participants 1 317 290 users of antihypertensive drugs with a diagnosis of hypertension. Main outcome measures Resistant hypertension was defined as concurrent use of three antihypertensive drugs inclusive of a diuretic, uncontrolled hypertension (≥140/90 mm Hg), and adherence to the prescribed drug regimen, or concurrent use of four antihypertensive drugs inclusive of a diuretic and adherence to the prescribed drug regimen. To determine incidence, the numerator was new cases of resistant hypertension and the denominator was person years of those with treated hypertension and at risk of developing resistant hypertension. To determine prevalence, the numerator was total number of cases with resistant hypertension and the denominator was those with treated hypertension. Prevalence and incidence were age standardised to the 2015 hypertensive population. Results The age standardised incidence of resistant hypertension increased from 0.93 cases per 100 person years (95% confidence interval 0.87 to 1.00) in 1996 to a peak level of 2.07 cases per 100 person years (2.03 to 2.12) in 2004. Incidence then decreased to 0.42 cases per 100 person years (0.40 to 0.44) in 2015. Age standardised prevalence increased from 1.75% (95% confidence interval 1.66% to 1.83%) in 1995 to a peak of 7.76% (7.70% to 7.83%) in 2007. Prevalence then plateaued and subsequently declined to 6.46% (6.38% to 6.54%) in 2015. Compared with patients aged 65-69 years, those aged 80 or more years were more likely to have prevalent resistant hypertension throughout the study period. Conclusions Prevalent resistant hypertension has plateaued and decreased in recent years, consistent with a decrease in incidence from 2004 onwards. Despite this, resistant hypertension is common in the UK hypertensive population. Given the importance of hypertension as a modifiable risk factor for cardiovascular disease, reducing uncontrolled hypertension should remain a population health focus.

Assessment of Knowledge on Hypertension among Hypertensive Patients in Bandung City: A Preliminary Study

“…Prevalensi penyakit ini semakin meningkat di seluruh dunia, diperkirakan satu dari empat orang penduduk di negara maju menderita hipertensi. 1,2 Jika penyakit ini tidak terkontrol maka akan menyerang organ yang dapat menyebabkan suatu serangan jantung, stroke, gangguan ginjal, serta berbagai komplikasi penyakit lainnya. Beberapa penelitian lain melaporkan bahwa hipertensi yang tidak di kontrol dengan baik memberikan peluang tujuh kali lebih besar menyebabkan stroke, enam kali lebih besar congestive heart failure, dan tiga kali lebih besar serangan jantung.…”

Incidence, prevalence, and predictors of treatment‐resistant hypertension with intensive blood pressure lowering

“…After excluding patients with insufficient data or follow‐up (9%) and poor adherence, they found that 1.9% of patients developed TRH over a median 1.5 years and observed a crude incidence rate of 0.7 per 100 patient‐years. In the second study, researchers analyzed EHR data from 1.32 million primary care patients with treated hypertension contained in the UK Clinical Practice Research Datalink database for cases of TRH (again, using the prior US definition and excluding patients for nonadherence) . From 1995 to 2015, they found a crude incidence rate ranging between 0.4 and 2.1 per 100 person‐years, and point prevalences between 1.8% and 8.2%, depending on the year.…”

“…To our knowledge, only two prior studies have published data on TRH incidence, both of which used electronic health record (EHR) data from real-world treatment settings, and both assessed incidence of TRH using the former definition (with BP control as <140/90 mm Hg) under a BP target < 140/90 mm Hg. 16,17 In the first study, researchers assessed the incidence of TRH among 205 750 patients with incident treated hypertension in the Kaiser Permanente system. 16 After excluding patients with insufficient data or follow-up (9%) and poor adherence, they found that 1.9% of patients developed TRH over a median 1.5 years and observed a crude incidence rate of 0.7 per 100 patient-years.…”

“…In the second study, researchers analyzed EHR data from 1.32 million primary care patients with treated hypertension contained in the UK Clinical Practice Research Datalink database for cases of TRH (again, using the prior US definition 8 and excluding patients for nonadherence). 17 From 1995 to 2015, they found a crude incidence rate ranging between 0.4 and 2.1 per 100 person-years, and point prevalences between 1.8% and 8.2%, depending on the year. In contrast, we observed a crude incidence rate of 9.4 per 100 person-years and a prevalence between 7.5% and 14% (among those with non-resistant hypertension at baseline) at year 1, using a similar TRH definition as in these studies and under mostly similar hypertension treatment guidance (excepting earlier years in the UK study).…”

The comparative effectiveness of fourth‐line drugs in resistant hypertension: An application in electronic health record data

“…Resistant hypertension (RH) is defined as BP that remains ≥140/90mmHg despite being treated with maximum, or best tolerated doses, of three or more anti‐hypertensive drugs, one of which should be a diuretic . Almost 7% of the treated hypertensive population in the United Kingdom has RH, representing approximately 800 000 people . Those with RH have worse health outcomes than those with “standard” hypertension, which double the risk of cardiovascular events .…”