Underutilization of Treatment for Black Adults With Apparent Treatment-Resistant Hypertension,Hypertension

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Underutilization of Treatment for Black Adults With Apparent Treatment-Resistant Hypertension
Hypertension ( IF 8.3 ) Pub Date : 2020-11-01 , DOI: 10.1161/hypertensionaha.120.14836
Aisha T Langford _{1,

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11} , Oluwasegun P Akinyelure _{1,

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11} , Tony L Moore _{1,

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11} , George Howard _{1,

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11} , Yuan-I Min _{1,

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11} , William B Hillegass _{1,

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11} , Adam P Bress _{1,

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11} , Gabriel S Tajeu _{1,

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11} , Mark Butler _{1,

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11} , Byron C Jaeger _{1,

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11} , Yuichiro Yano _{1,

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11} , Daichi Shimbo _{1,

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11} , Gbenga Ogedegbe _{1,

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11} , David Calhoun _{1,

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11} , John N Booth _{1,

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11} , Paul Muntner _{1,

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Affiliation

From the Department of Population Health, NYU School of Medicine (A.T.L., M.B., G.O.).
Departments of Epidemiology (O.P.A., T.L.M., J.N.B., P.M.), University of Alabama at Birmingham.
Departments of Biostatistics (G.H., B.C.J.), University of Alabama at Birmingham.
Departments of Medicine (D.C.), University of Alabama at Birmingham.
Departments of Data Science (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson.
Departments of Medicine (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson.
Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.).
Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (G.S.T.).
Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (Y.Y.).
and Department of Medicine, Columbia Hypertension Center, Columbia University Medical Center, New York, NY (D.S.).
CTI Clinical Trials and Consulting Services, Inc., Covington, KY (J.N.B.).

Supplemental Digital Content is available in the text. Resistant hypertension, defined as blood pressure levels above goal while taking ≥3 classes of antihypertensive medication or ≥4 classes regardless of blood pressure level, is associated with increased cardiovascular disease risk. The 2018 American Heart Association Scientific Statement on Resistant Hypertension recommends healthy lifestyle habits and thiazide-like diuretics and mineralocorticoid receptor antagonists for adults with resistant hypertension. The term apparent treatment-resistant hypertension (aTRH) is used when pseudoresistance cannot be excluded. We estimated the use of healthy lifestyle factors and recommended antihypertensive medication classes among US Black adults with aTRH. Data were pooled for Black participants in the JHS (Jackson Heart Study) in 2009 to 2013 (n=2496) and the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) in 2013 to 2016 (n=3786). Outcomes included lifestyle factors (not smoking, not consuming alcohol, ≥75 minutes of vigorous-intensity or ≥150 minutes of moderate or vigorous physical activity per week, and body mass index <25 kg/m2) and recommended antihypertensive medications (thiazide-like diuretics and mineralocorticoid receptor antagonists). Overall, 28.3% of participants who reported taking antihypertensive medication had aTRH. Among participants with aTRH, 14.5% and 1.2% had ideal levels of 3 and 4 of the lifestyle factors, respectively. Also, 5.9% of participants with aTRH reported taking a thiazide-like diuretic, and 9.8% reported taking a mineralocorticoid receptor antagonist. In conclusion, evidence-based lifestyle factors and recommended pharmacological treatment are underutilized in Black adults with aTRH. Increased use of lifestyle recommendations and antihypertensive medication classes specifically recommended for aTRH may improve blood pressure control and reduce cardiovascular disease–related morbidity and mortality among US Black adults. Graphic Abstract A graphic abstract is available for this article.

中文翻译：

对有明显难治性高血压的黑人成人的治疗利用不足

文本中提供了补充数字内容。顽固性高血压，定义为在服用≥3 类降压药或≥4 类而不管血压水平时血压水平高于目标，与心血管疾病风险增加有关。2018 年美国心脏协会关于顽固性高血压的科学声明建议对成人顽固性高血压患者使用健康的生活习惯和噻嗪类利尿剂和盐皮质激素受体拮抗剂。当不能排除假性抵抗时，使用术语表观难治性高血压（aTRH）。我们估计了美国黑人成人 aTRH 对健康生活方式因素的使用和推荐的抗高血压药物类别。汇总了 2009 年至 2013 年 JHS（杰克逊心脏研究）（n=2496）和 2013 年至 2016 年 REGARDS 研究（中风地理和种族差异的原因）（n=3786）中黑人参与者的数据。结果包括生活方式因素（不吸烟、不饮酒、每周≥75 分钟的高强度运动或≥150 分钟的中等或剧烈的体力活动，以及体重指数<25 kg/m2）和推荐的抗高血压药物（噻嗪类药物利尿剂和盐皮质激素受体拮抗剂）。总体而言，报告服用抗高血压药物的参与者中有 28.3% 患有 aTRH。在患有 aTRH 的参与者中，14.5% 和 1.2% 的生活方式因素的理想水平分别为 3 和 4。此外，5.9% 的 aTRH 参与者报告服用噻嗪类利尿剂，9%。8% 报告服用盐皮质激素受体拮抗剂。总之，以证据为基础的生活方式因素和推荐的药物治疗在患有 aTRH 的黑人成人中没有得到充分利用。增加使用专门针对 aTRH 的生活方式建议和抗高血压药物类别可能会改善美国黑人成年人的血压控制并降低心血管疾病相关的发病率和死亡率。图形摘要本文提供图形摘要。增加使用专门针对 aTRH 的生活方式建议和抗高血压药物类别可能会改善美国黑人成年人的血压控制并降低心血管疾病相关的发病率和死亡率。图形摘要本文提供图形摘要。增加使用专门针对 aTRH 的生活方式建议和抗高血压药物类别可能会改善美国黑人成年人的血压控制并降低心血管疾病相关的发病率和死亡率。图形摘要本文提供图形摘要。

更新日期：2020-11-01

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