Novel study deepens knowledge of treatment-resistant hypertension

Date:
June 26, 2023
Source:
Cedars-Sinai Medical Center
Summary:
Novel research found that apparent resistant hypertension (aRH)
prevalence was lower in a real-world sample than previously
reported, but still relatively frequent -- affecting nearly 1 in
10 hypertensive patients.


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For many patients with hypertension -- an elevated blood pressure that
can lead to stroke or heart attack -- medication keeps the condition at
bay. But what happens when medication that physicians usually prescribe
doesn't work? Known as apparent resistant hypertension (aRH), this form
of high blood pressure requires more medication and medical management.

Novel research from investigators in the Smidt Heart Institute at
Cedars-Sinai, published today in the peer-reviewed journal Hypertension,
found that aRH prevalence was lower in a real-world sample than previously reported, but still relatively frequent -- affecting nearly 1 in 10 hypertensive patients.

Through their analysis, investigators also learned that patients with
well- managed aRH were more likely to be treated with a commonplace
medication called mineralocorticoid receptor antagonist, or MRA. These
MRA treatments were used in 34% of patients with controlled aRH, but
only 11% of patients with uncontrolled aRH.

"Apparent resistant hypertension is more common than many would
anticipate," said Joseph Ebinger, MD, assistant professor of Cardiology
in the Smidt Heart Institute and corresponding author of the study. "We
also learned that within this high-risk population, there are large
differences in how providers treat high blood pressure, exemplifying a
need to standardize care." Study findings were based on a unique design,
which used clinically generated data from the electronic health records
of three large, geographically diverse healthcare organizations. Of the 2,420,468 patients analyzed in the study, 55% were hypertensive. Of these hypertension patients, 8.5%, or 113,992 individuals, met criteria for aRH.

According to Ebinger, treating aRH can be just as tricky as diagnosing it.

In fact, the "apparent" in apparent resistant hypertension stems from
the fact that before diagnosis, medical professionals must first rule
out other potential reasons for a patient's blood pressure to be high.

These reasons might include medication non-adherence, inappropriate
medication selection, or artificially elevated blood pressure in the
doctor's office - - known as "white coat hypertension." "Large amounts of
data tell us that patients with aRH, compared to those with non-resistant
forms of hypertension, are at greatest risk for adverse cardiovascular
events," said Ebinger, director of Clinical Analytics in the Smidt Heart Institute. "Identifying these patients and possible causes for their
elevated blood pressure is increasingly important." The takeaway, Ebinger says, is awareness -- for both medical professionals and patients. He
says providers should be mindful that if it's taking four or more antihypertensive medications to control a patient's blood pressure,
they should consider evaluation for alternative causes of hypertension,
or refer patients to a specialist.

Similarly, patients should lean on their medical providers to help them navigate the complex disease, including having a conversation around
strategies for remembering to take their medication and addressing
possible treatment side effects.

Treating patients with complex cardiac issues like aRH is at the heart
of Cedars-Sinai's expertise.

The Smidt Heart Institute was recently awarded the American Heart
Association's Comprehensive Hypertension Center Certification, recognizing
the institute's commitment to following proven, research-based treatment guidelines to care for people with complex or difficult-to-treat
hypertension.

"This accreditation, coupled with our clinical and research expertise in hypertensive diseases, serves as a mark of excellence," said Christine M.

Albert, MD, MPH, chair of the Department of Cardiology and the Lee
and Harold Kapelovitz Distinguished Chair in Cardiology. "These efforts
signal to patients, healthcare providers, and the community that the Smidt Heart Institute is committed to delivering evidence-based, comprehensive
care for hypertension." Funding: This work was supported in part by Cedars-Sinai Medical Center and by the National Institutes of Health
grant K23-HL153888.

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========================================================================== Story Source: Materials provided by Cedars-Sinai_Medical_Center. Note:
Content may be edited for style and length.


========================================================================== Journal Reference:
1. Joseph E. Ebinger, Ty J. Gluckman, Jose Magraner, Shih Ting Chiu,
Deanna
Rider, Chelsey Thomas, Sandeep R. Das, P. Michael Ho, Satya
Shreenivas, Steven Bradley. Characterization of Individuals With
Apparent Resistant Hypertension Using Contemporary Guidelines:
Insights From CV-QUIC.

Hypertension, 2023; DOI: 10.1161/HYPERTENSIONAHA.123.20894 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2023/06/230626164131.htm

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