15 August 2011
MedWire News: Doctors may be able to use certain clinical characteristics to help identify and improve the care of patients with untreated, under-treated, or treatment-resistant hypertension, researchers report.
Male gender, a body mass index (BMI) below 25 kg/m2, absence of chronic kidney disease, a low risk for coronary heart disease, and making few healthcare visits were associated with untreated hypertension, report Brent Egan (Medical University of South Carolina, Charleston, USA) and colleagues in the journal Circulation.
Of the 33 million patients who have uncontrolled hypertension, including patients who are unaware of their condition and those who are aware, the majority remain untreated, the team explains.
Moreover, the prevalence of patients with apparent treatment-resistant hypertension (aTRH; hypertension uncontrolled on three or more, or controlled on four or more antihypertensive medications) is increasing.
The study included 13,375 hypertensive adults from the National Health and Nutrition Examination Surveys subdivided into three periods: 1988–1994, 1999–2004, and 2005–2008.
The findings revealed that more than half of patients with uncontrolled hypertension (defined as a mean systolic blood pressure of ≥140/90 mmHg) were untreated in each of the three survey periods, including 52.2% of patients in 2005-2008. Multivariate analysis showed that male gender, making 0–1 healthcare visits per year, absence of chronic kidney disease, having a BMI below 25 kg/m2, and a Framingham 10-year coronary risk score of less than 10% were significantly associated with untreated hypertension.
Treated patients with uncontrolled hypertension were significantly more likely to have a higher Framingham 10-year coronary risk score than those who had controlled hypertension.
The proportion of treated patients with aTRH increased significantly from 15.9% in 1998–2004 to 28.0% in 2005–2008, suggesting that a “growing proportion of hypertensive patients appear to be resistant to treatment,” the authors report.
These patients were significantly more likely to make four or more healthcare visits annually, be obese, have chronic kidney disease, and have a Framingham 10-year coronary risk score greater than 20%, they continue.
“Integrated healthcare research, policy, and delivery initiatives are needed… to develop more efficacious antihypertensive agents, and to improve methods for selecting effective antihypertensive combinations for individual patients,” Egan et al conclude.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
Circulation 2011; Advance online publication
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