Apparent treatment-resistant hypertension (aTRH) is associated with higher prevalence of secondary hypertension, greater risk for adverse pressure-related clinical outcomes, and influences diagnostic and therapeutic decision-making. We previously showed that cross-sectional prevalence estimates of aTRH are lower than its true prevalence as patients with uncontrolled hypertension undergoing intensification/optimization of therapy will, over time, increasingly satisfy diagnostic criteria for aTRH. aTRH was assessed in an urban referral hypertension clinic using a 140/90 mm Hg goal blood pressure target in 745 patients with uncontrolled blood pressure, who were predominately African-American (86%) and female (65%). Analyses were stratified according to existing prescription of diuretic at initial visit. Risk for aTRH was estimated using logistic regression with patient characteristics at index visit as predictors. Among those prescribed diuretics, 84/363 developed aTRH; the risk score discriminated well (area under the receiver operating curve = 0.77, bootstrapped 95% CI [0.71, 0.81]). In patients not prescribed a diuretic, 44/382 developed aTRH, and the risk score showed a significantly better discriminative ability (area under the receiver operating curve = 0.82 [0.76, 0.87]; P < .001). In the diuretic and nondiuretic cohorts, 145/363 and 290/382 of patients had estimated risks for development of aTRH <15%. Of these low-risk patients, 139/145 and 278/290 did not develop aTRH (negative predictive value, diuretics − 0.94 [0.91, 0.98], no diuretics − 0.95 [0.93, 0.97]). We created a novel clinical score that discriminates well between those who will and will not develop aTRH, especially among those without existing diuretic prescriptions. Irrespective of baseline diuretic treatment status, a low-risk score had very high negative predictive value.

明显的抗药性高血压（aTRH）与继发性高血压的患病率较高，与不良压力相关的临床结果较高的风险相关，并影响诊断和治疗决策。我们先前显示，aTRH的横断面患病率估计值低于其真实患病率，因为随着时间的流逝，接受强化/优化治疗的无法控制的高血压患者将越来越满足aTRH的诊断标准。在城市转诊高血压诊所使用140/90 mm Hg目标血压目标对745名不受控制的血压患者中的aTRH进行了评估，这些患者主要是非洲裔美国人（86％）和女性（65％）。初诊时根据利尿剂的现有处方进行分析。使用logistic回归以指数访视时的患者特征作为预测因素来估计aTRH的风险。在那些规定的利尿剂中，有84/363产生了aTRH。风险评分可很好地区分（接收者工作曲线下的面积= 0.77，自举95％CI [0.71，0.81]）。在未使用利尿剂的患者中，有44/382的患者出现了aTRH，并且危险评分显示出明显更好的判别能力（接受者手术曲线下的面积= 0.82 [0.76，0.87]；P  <.001）。在利尿和非利尿队列中，估计145/363和290/382的患者发生aTRH的风险<15％。在这些低风险患者中，139/145和278/290没有发展aTRH（阴性预测值，利尿剂-0.94 [0.91，0.98]，无利尿剂-0.95 [0.93，0.97]）。我们创建了一个新颖的临床评分，可以很好地区分将要和不会发展aTRH的患者，尤其是那些没有利尿剂处方的患者。不管基线利尿剂治疗状态如何，低风险评分具有很高的阴性预测价值。