True antihypertensive efficacy of sequential nephron blockade in patients with resistant hypertension and confirmed medication adherence

Beaussier, Hélène; Boutouyrie, Pierre; Bobrie, Guillaume; Frank, Michael; Laurent, Stéphane; François, Clément; Azizi, Michel

doi:10.1097/hjh.0000000000000737

Cited by 29 publications

(9 citation statements)

References 42 publications

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“…Several limitations of our study deserve mention. First, we only had participant reported prescriptions and did not have information on prescription adherence which limits our ability to differentiate between true treatment-resistant hypertension and uncontrolled hypertension as the result of medication noncompliance [24]. Second, medications are assessed at a single timepoint due to the cross-sectional nature of NHANES.…”

Section: Discussionmentioning

confidence: 99%

Resistant hypertension and cardiovascular disease mortality in the US: results from the National Health and Nutrition Examination Survey (NHANES)

et al. 2019

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Background Apparent treatment-resistant hypertension (aTRH) is a common condition associated with risk of cardiovascular events. However, the risk of cardiovascular mortality associated with aTRH in the US population is unknown. We aimed to assess the risk of cardiovascular disease (CVD) mortality associated with aTRH in the US population. Methods We analyzed data from 6357 adult hypertensive participants of the National Health and Nutrition Examination Survey (1988–1994 and 1999–2010) linked to the National Death Index. Based on presence of uncontrolled hypertension [blood pressure (BP) ≥140/90 mmHg] and the number of antihypertensives prescribed, we classified participants into the following groups: non-aTRH (BP < 140/90 mmHg and ≤ 3 antihypertensives); controlled aTRH (BP < 140/90 mmHg and ≥ 4 antihypertensives); and uncontrolled aTRH (BP ≥140/90 mmHg and ≥ 3 antihypertensives). Results Of the 6357 participants, 1522 had aTRH, representing a US prevalence of 7.6 million. Of the participants with aTRH, 432 had controlled aTRH and 1090 had uncontrolled aTRH. During follow-up (median 6 years), there were 550 CVD deaths. The cumulative incidence of CVD mortality was significantly higher in the aTRH group compared with non-aTRH group (log-rank p < 0.001). In fully adjusted models, aTRH was associated with a 47% higher risk of CVD mortality compared with the non-aTRH group [1.47 (1.1–1.96)]. Similar increase in risk of CVD mortality was noted across aTRH subgroups compared with the non-aTRH group: controlled aTRH [1.66 (1.03–2.68)] and uncontrolled aTRH [1.43 (1.05–1.94)]. Among non-aTRH subgroups, those on 3 antihypertensive medications had a 35% increased risk of CVD mortality than those on < 3 medications [1.35 (0.98–1.86)]. Conclusions aTRH is a common condition, affecting approximately 7.6 million Americans. Regardless of BP control, people with aTRH remain at a higher risk of cardiovascular outcomes. The risk of cardiovascular disease mortality remains high among those with controlled BP on 3 medications (non-aTRH) or ≥ 4 medications (controlled aTRH), groups not generally considered at high risk. Future risk reduction interventions should consider focusing on these high-risk groups. Electronic supplementary material The online version of this article (10.1186/s12882-019-1315-0) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Resistant hypertension and cardiovascular disease mortality in the US: results from the National Health and Nutrition Examination Survey (NHANES)

et al. 2019

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“…Supplementary 22 50 58 56 ± 7 Azizi (2016) 28 85 NR NR Beaussier (2015) 29 164 55 55 ± 10 Brinker (2014) 11 56 NR NR Bunker (2011) 30 37 18 89 54 Ewen (2015) 38 27 60 61.9 ± 9.9 Ewen (2015) 39 100 67 62.7 ± 10.6 Florczak (2015) 21…”

Section: Supplementary Appendixmentioning

confidence: 99%

The Prevalence of Non-Adherence in Patients with Resistant Hypertension: a Systematic Review and Meta-Analysis

Bourque

Ilin

Ruzicka

et al. 2020

Preprint

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Background: Resistant hypertension is quite prevalent and a risk factor for cardiovascular events. Patients with suspected resistant hypertension undergo more screening intensity for secondary hypertension, despite some of them being non-adherent to prescribed pharmacotherapy. The prevalence of non-adherence in this setting varies from about 5 to 80% in the published literature. Apart from the wide range, the relation between method of assessment and prevalence is not well established. Our objective was to establish the overall prevalence of non-adherence in the apparent treatment resistant hypertension population, explore causes of heterogeneity, and evaluate the effect of the method of assessment on the estimate of non-adherence. Methods: We performed a systematic review and meta-analysis. MEDLINE, EMBASE Classic+EMBASE, Cochrane, CINAHL, and Web of Science were searched for relevant articles. Details about the method of adherence assessment were extracted from each included article and grouped into direct and indirect. Pooled analysis was performed using the random effects model and heterogeneity was explored with metaregression and subgroup analyses. Results: The literature search yielded 1428 studies, of which 36 were included. The pooled prevalence of non-adherence was 35% (95% confidence interval 25 to 46 %). For indirect methods of adherence assessment, it was 25% (95% CI 15 to 39 %), whereas for direct methods of assessment, it was 44% (95% CI 32 to 57 %). Metaregression suggested gender, age, and time of publication as potential factors contributing to the heterogeneity. Conclusions: Non-adherence to pharmacotherapy is quite common in resistant hypertension, with the prevalence varying with the methods of assessment.

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“…Similar to the general treatment of hypertension, lowering BP results in a significant reduction of major cardiovascular events and sequelae [5,6]. However, while there is evidence of a BP-lowering effect for a combination of up to four drug classes [7][8][9][10], in most patients with RH, treatment is characterized by multidrug combinations with low scientific evidence of their BP-lowering effects and low drug adherence is frequent [11]. Beyond drug treatment, lifestyle optimization can reduce BP, as supported by a recent study on an intensified lifestyle modification over several weeks [12], but there are concerns about the durability of such a complex intervention.…”

Section: Resistant Hypertensionmentioning

confidence: 99%

Renal Denervation for Resistant Hypertension: A Concise Update on Treatment Options and the Latest Clinical Evidence

Fengler

2022

Cardiol Ther

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Evidence from recent sham-controlled trials supports the use of endovascular renal denervation (RDN) to lower blood pressure in general as well as in treatment-resistant hypertension. According to recent studies, the effects of RDN are long lasting. Newer technologies using multipolar radiofrequency catheters and an additional ablation of the renal side branches as well as ultrasound with improved circumferential tissue penetration have made these advances possible. This has initiated a change of the perspective on RDN in clinical guidelines and has thereby set a cornerstone for a broader clinical application of RDN in the future.

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True antihypertensive efficacy of sequential nephron blockade in patients with resistant hypertension and confirmed medication adherence

Abstract: Medication adherence contributes to BP-lowering and regression of target organ damage. The differential effects of SNB and SRASB is observed in patients with acceptable medication adherence, and not in patients with low medication adherence.

Cited by 29 publications

References 42 publications

Resistant hypertension and cardiovascular disease mortality in the US: results from the National Health and Nutrition Examination Survey (NHANES)

Resistant hypertension and cardiovascular disease mortality in the US: results from the National Health and Nutrition Examination Survey (NHANES)

The Prevalence of Non-Adherence in Patients with Resistant Hypertension: a Systematic Review and Meta-Analysis

Renal Denervation for Resistant Hypertension: A Concise Update on Treatment Options and the Latest Clinical Evidence

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