Document Detail

Characteristics of resistant hypertension in a large, ethnically diverse hypertension population of an integrated health system.
MedLine Citation:
PMID:  24079679     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To evaluate the prevalence of and characterize resistant hypertension in a large representative population with successful hypertension management and reliable health information.
PATIENT AND METHODS: We performed a cross-sectional study using clinical encounter, laboratory, and administrative information from the Kaiser Permanente Southern California health system between January 1, 2006, and December 31, 2007. From individuals older than 17 years with hypertension, resistant hypertension was identified and prevalence was determined. Multivariable logistic regression was used to calculate odds ratios (ORs), with adjustments for demographic characteristics, clinical variables, and medication use.
RESULTS: Of 470,386 hypertensive individuals, 60,327 (12.8%) were identified as having resistant disease, representing 15.3% of those taking medications. Overall, 37,061 patients (7.9%) had uncontrolled hypertension while taking 3 or more medicines. The ORs (95% CIs) for resistant hypertension were greater for black race (1.68 [1.62-1.75]), older age (1.11 [1.10-1.11] for every 5-year increase), male sex (1.06 [1.03-1.10]), and obesity (1.46 [1.42-1.51]). Medication adherence rates were higher in those with resistant hypertension (93% vs 89.8%; P<.001). Chronic kidney disease (OR, 1.84; 95% CI, 1.78-1.90), diabetes mellitus (OR, 1.58; 95% CI, 1.53-1.63), and cardiovascular disease (OR, 1.34; 95% CI, 1.30-1.39) were also associated with higher risk of resistant hypertension.
CONCLUSION: In a more standardized hypertension treatment environment, we observed a rate of resistant hypertension comparable with that of previous studies using more fragmented data sources. Past observations have been limited due to nonrepresentative populations, reliability of the data, heterogeneity of the treatment environments, and less than ideal control rates. This cohort, which was established using an electronic medical record-based approach, has the potential to provide a better understanding of resistant hypertension and outcomes.
John J Sim; Simran K Bhandari; Jiaxiao Shi; In Lu A Liu; David A Calhoun; Elizabeth A McGlynn; Kamyar Kalantar-Zadeh; Steven J Jacobsen
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Mayo Clinic proceedings     Volume:  88     ISSN:  1942-5546     ISO Abbreviation:  Mayo Clin. Proc.     Publication Date:  2013 Oct 
Date Detail:
Created Date:  2013-10-01     Completed Date:  2013-12-11     Revised Date:  2014-10-09    
Medline Journal Info:
Nlm Unique ID:  0405543     Medline TA:  Mayo Clin Proc     Country:  England    
Other Details:
Languages:  eng     Pagination:  1099-107     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
African Americans / statistics & numerical data
Age Distribution
Antihypertensive Agents / administration & dosage*,  therapeutic use
California / epidemiology
Cardiovascular Diseases / epidemiology
Coronary Vasospasm / epidemiology*,  ethnology
Cross-Cultural Comparison
Delivery of Health Care, Integrated / statistics & numerical data*
Diabetes Mellitus / epidemiology
Drug Resistance
Hypertension / epidemiology*,  ethnology
Logistic Models
Nutrition Surveys
Obesity / epidemiology*
Sex Distribution
Grant Support
Reg. No./Substance:
0/Antihypertensive Agents

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