Resistant Hypertension: Concepts and Approach to Management

Sander, Gary E.; Giles, Thomas D.

doi:10.1007/s11906-011-0226-7

Cited by 26 publications

(9 citation statements)

References 60 publications

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“…The end result is often a major clinical decompensation event that could have been largely preventable. In addition to these clinical consequences, these challenges also result in economic consequences such as high utilization of inpatient resources and emergency departments, as well as readmissions ( Sander & Giles, 2011 ). One would surmise that better, more informed management of disease would lead to better long-term health outcomes and thereby lower health care resource utilization.…”

Section: Introductionmentioning

confidence: 99%

A prospective randomized trial examining health care utilization in individuals using multiple smartphone-enabled biosensors

Bloss

Wineinger

Peters

et al. 2016

PeerJ

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Background. Mobile health and digital medicine technologies are becoming increasingly used by individuals with common, chronic diseases to monitor their health. Numerous devices, sensors, and apps are available to patients and consumers–some of which have been shown to lead to improved health management and health outcomes. However, no randomized controlled trials have been conducted which examine health care costs, and most have failed to provide study participants with a truly comprehensive monitoring system. Methods. We conducted a prospective randomized controlled trial of adults who had submitted a 2012 health insurance claim associated with hypertension, diabetes, and/or cardiac arrhythmia. The intervention involved receipt of one or more mobile devices that corresponded to their condition(s) (hypertension: Withings Blood Pressure Monitor; diabetes: Sanofi iBGStar Blood Glucose Meter; arrhythmia: AliveCor Mobile ECG) and an iPhone with linked tracking applications for a period of 6 months; the control group received a standard disease management program. Moreover, intervention study participants received access to an online health management system which provided participants detailed device tracking information over the course of the study. This was a monitoring system designed by leveraging collaborations with device manufacturers, a connected health leader, health care provider, and employee wellness program–making it both unique and inclusive. We hypothesized that health resource utilization with respect to health insurance claims may be influenced by the monitoring intervention. We also examined health-self management. Results & Conclusions. There was little evidence of differences in health care costs or utilization as a result of the intervention. Furthermore, we found evidence that the control and intervention groups were equivalent with respect to most health care utilization outcomes. This result suggests there are not large short-term increases or decreases in health care costs or utilization associated with monitoring chronic health conditions using mobile health or digital medicine technologies. Among secondary outcomes there was some evidence of improvement in health self-management which was characterized by a decrease in the propensity to view health status as due to chance factors in the intervention group.

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Section: Introductionmentioning

confidence: 99%

A prospective randomized trial examining health care utilization in individuals using multiple smartphone-enabled biosensors

Bloss

Wineinger

Peters

et al. 2016

PeerJ

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“…4) Recently, de la Sierra, et al presented analysis of data from their large registry of Spanish patients who had 24-hour ambulatory BP monitoring performed. 5) They gathered data from > 68,000 hypertensive patients and determined that 12.2% had resistant hypertension.…”

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confidence: 99%

Effectiveness of the Direct Renin Inhibitor, Aliskiren, in Patients With Resistant Hypertension

Yoshitomi¹,

Kawanishi²,

Yamaguchi³

et al. 2013

Int. Heart J.

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SummaryCurrently there is no consensus regarding which add-on therapy to use in resistant hypertension. We have conducted an open observational study of the use of aliskiren in resistant hypertensive patients. Forty-three patients with resistant hypertension were included in the study. The inclusion criteria were as follows: 1) office blood pressure (BP) > 140/90 mmHg despite treatment with at least three or more antihypertensive drugs; 2) no prior therapy with aliskiren; and 3) no renal insufficiency. Follow-up BP was determined at 1 and 3 months. Baseline BP was 153 ± 12/79 ± 12 mmHg. After 3 months, systolic BP (SBP) and diastolic BP (DBP) dropped significantly: 140 ± 19/73 ± 13 mmHg (P < 0.0001). Twenty-one patients (49%) had an office BP < 140/90 mmHg, and these patients were assigned to the good BP control group. Another 22 were placed into the poor BP control group. BP reductions from baseline in the good BP control group (SBP/ DBP: 19 ± 11/8 ± 7 mmHg) were larger than those in the poor BP control group (5 ± 15/3 ± 9 mmHg, P < 0.05). Mean BP (MBP) values at baseline, 1, and 3 months were higher in the poor BP control group. There was no significant difference in pulse pressure at baseline between the 2 groups. In multivariate analysis, only MBP at baseline correlated with lack of BP control. Aliskiren administration to resistant hypertensive patients was effective in reducing BP. The present findings suggest aliskiren may be useful as a fourth-line or fifth-line treatment added to other drugs in the treatment of resistant hypertension. (Int Heart J 2013; 54: 88-92) Key words: Uncontrolled hypertension, Pulse pressure, Mean blood pressure A lthough various authors use different definitions, resistant hypertension is defined as blood pressure (BP) that requires the use of four or more antihypertensive agents, whether controlled or uncontrolled. 1) Approximately 30% of adults who have hypertension are unaware of their condition, and about half of patients receiving treatment in Japan do not achieve the modest goal of < 140 / 90 mmHg. 2) In the absence of a definitive study, clinical trials have been largely relied upon as surrogate opportunities to estimate the prevalence of resistant hypertension. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) is likely the most relevant, in that it included a large and diverse cohort, and, per protocol, subjects were to have continued escalation of their treatment regimen as long as the BP remained elevated. At the end of the 5-year treatment period, uncontrolled hypertension was common in ALLHAT, with 34% of subjects never having achieved BP control and with 27% of subjects receiving ≥ 3 antihypertensive medications. 3) Data from a large, community-based study indicated that 12.7% of hypertensive patients were uncontrolled on three or more medications. 4) Recently, de la Sierra, et al presented analysis of data from their large registry of Spanish patients who had 24-hour ambulatory BP monitoring performed. 5) They gathered dat...

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“…First used concurrently with RHTN, the term refractory hypertension has been redefined ten years ago to characterize a different group of patients with a more severe form of RHTN [23].…”

Section: Refractory Hypertension: a Specific Sub-group Of Patients Wimentioning

confidence: 99%

Resistant Hypertension: Novel Insights

Lamirault

Artifoni²,

Daniel

et al. 2020

CHYR

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: Hypertension is the most common chronic disease and the leading risk factor for disability and premature deaths in the world, accounting for more than 9 million deaths annually. Resistant hypertension is a particularly severe form of hypertension. It was described 50 years ago and since then has been a very active field of research. This review aims at summarizing the most recent findings on resistant hypertension. : The recent concepts of apparent- and true-resistant hypertension have stimulated a more precise definition of resistant hypertension taking into account not only the accuracy of blood pressure measurement and pharmacological class of prescribed drugs but also patient adherence to drugs and life-style recommendations. : Recent epidemiological studies have reported a 10% prevalence of resistant hypertension among hypertensive subjects and demonstrated the high cardiovascular risk of these patients. In addition, these studies identified subgroups of patients with even higher morbidity and mortality risk, probably requiring a more aggressive medical management. : In the meantime, guidelines provided more standardized clinical work-up to identify potentially reversible causes for resistant hypertension such as secondary hypertension. The debate is however still ongoing on which would be the optimal method(s) to screen for non-adherence to hypertension therapy, recognized as the major cause for (pseudo)-resistance to treatment. : Recent randomized clinical trials have demonstrated the strong benefit of anti-aldosterone drugs (mostly spironolocatone) as fourth-line therapies in resistant hypertension whereas clinical trials with device-based therapies displayed contrasting results. New trials with improved devices and more carefully selected patients with resistant hypertension are ongoing.

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Resistant Hypertension: Concepts and Approach to Management

Cited by 26 publications

References 60 publications

A prospective randomized trial examining health care utilization in individuals using multiple smartphone-enabled biosensors

A prospective randomized trial examining health care utilization in individuals using multiple smartphone-enabled biosensors

Effectiveness of the Direct Renin Inhibitor, Aliskiren, in Patients With Resistant Hypertension

Resistant Hypertension: Novel Insights

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