Prevalence and Factors Associated With Resistant Hypertension in a Large Health Maintenance Organization in Israel

Abstract

A rterial hypertension is associated with an increased risk of cardiovascular morbidity and mortality.1,2 Blood pressure (BP) reduction has been shown to reduce fatal and nonfatal outcomes in hypertensive patients. 3,4 Despite the improvement in diagnostic options and therapeutic interventions, observational studies continue to show persistently low rates of BP control in the general population of hypertensive patients. 5,6 In some of these patients, hypertension is resistant to treatment and persists despite the use of a combination of drugs. Multiple previous cross-sectional studies have consistently indicated an increased frequency of cardiovascular complications in patients with resistant hypertension (RH) compared with subjects without RH. 7-10Daugherty et al 11 in a longitudinal retrospective study found a 47% higher risk for cardiovascular complications in patients with RH compared with patients with non-RH. Studies reporting on RH have shown prevalence ranging between 3% and 38%. [7][8][9][12][13][14] However, these studies differ in the definition of RH (eg, number of drug classes included, time interval with uncontrolled BP), including or ignoring pharmacological treatment dosage and adherence to treatment, data source (eg, self-reported, physician-reported, or computerized database), method of BP assessment (eg, office or ambulatory BP monitoring), and use of a single or repeated assessments of BP. The current retrospective population-based study aimed at assessing the prevalence of RH in the hypertensive population of the Maccabi Healthcare Services (MHS) using its comprehensive computerized database, including drug dispense data. Methods Study PopulationAll data were obtained from the computerized databases of MHS. The study population included all patients aged >18 years who had entered the MHS's hypertension registry before January 1, 2010. Inclusion was based on ≥2 physician's diagnoses or hospital records and ≥2 BP measurements of systolic BP (SBP) ≥140 or diastolic BP (DBP) ≥ 90 mm Hg. For cases with abnormal measurements but no diagnoses, 4 documented measurements were required where ≥50% of the measurements were SBP >160 mm Hg or DBP >90 mm Hg. Also included were patients with ≥6 dispensed medications for hypertension. Patients were eligible for the study if they had had ≥2 BP measurements during a period of ≥6 months between January 1, 2010, and December 31, 2011. The mean (SD) number of BP measurements per patient was 3.9 (5.1). Patients who left MHS Abstract-Previous assessments of the prevalence of resistant hypertension (RH) in uncontrolled blood pressure (BP) have ranged from 3% to 30%. Using real-world data, our aim was to estimate the prevalence of RH in patients belonging to the Maccabi Healthcare Services, a 2-million-member health organization in Israel. From 2010 to 2011, all hypertensive patients with ≥2 recorded BP measurements during a minimum period of 6 months were identified. Patients were considered uncontrolled if their most recent BP during the study period and their mean...

The Prevalence of Resistant Hypertension Among Type 2 Diabetic Patients Attending the National Center for Diabetes, Endocrinology, and Genetics

“…Besides, a study conducted in Japan showed that increasing age is significantly associated with RH (P < 0.05) [19]. A study conducted in the Middle East, including 65,710 hypertensive patients, reported that elderly people were more able to have RH with a significant P-value of < 0.05 [24]. Obesity is another important significant finding, which has a strongly positive association with RH.…”

Carotid baroreflex activation therapy for resistant hypertension

“…45 When resistant hypertension is more rigorously defined as office BP consistently >140/90 mmHg and home or daytime ambulatory BP consistently >135/85 mmHg despite treatment with three or more of the five state-of-theart antihypertensive agents (calcium-channel blockers, angiotensin-converting-enzyme inhibitors, angiotensinreceptor blockers, potent thiazide-type diuretics, and vasodilating β-blocker), the prevalence might be as low as 2% of the hypertensive population. 43 Despite this much more conservative estimate, this prevalence still equates to 1.5-2.0 million people in the USA. In other words, 'truly resistant hypertension' is not an all-or-none designation and should be more accurately termed 'difficult primary hypertension' .…”

Renal denervation in treatment-resistant hypertension: a reappraisal

“…However, this subset also includes an unknown proportion of patients with secondary and white coat hypertension and poorly adherent patients. In the 2010-2011 database of a large Israeli healthcare organisation [34 ], resistant hypertensive patients defined as uncontrolled patients despite adherence to a drug regimen including a diuretic and at least 2 other antihypertensive drug classes at their maximal recommended dose accounted for only 2.2% of uncontrolled hypertensive patients and <1% of the total study population. This proportion may still be an overestimate, as screening for secondary or white coat resistant hypertension was performed only in a small minority of patients [34 ].…”

“…In the 2010-2011 database of a large Israeli healthcare organisation [34 ], resistant hypertensive patients defined as uncontrolled patients despite adherence to a drug regimen including a diuretic and at least 2 other antihypertensive drug classes at their maximal recommended dose accounted for only 2.2% of uncontrolled hypertensive patients and <1% of the total study population. This proportion may still be an overestimate, as screening for secondary or white coat resistant hypertension was performed only in a small minority of patients [34 ]. Along the same lines, in a single centre retrospective chart review, the proportion of patients with resistant hypertension decreased from 30.9% to 3.4% when triple therapy had to include maximally dosed medications including a diuretic [35 ].…”