Treatment-Resistant Hypertension

For many patients with hypertension — an elevated blood pressure that can lead to stroke or heart attack — medication keeps the condition at bay. But what happens when medication that physicians usually prescribe doesn’t work? Known as apparent resistant hypertension (aRH), this form of high blood pressure requires more medication and medical management.

Novel research from investigators in the Smidt Heart Institute at Cedars-Sinai, published today in the peer-reviewed journal Hypertension, found that aRH prevalence was lower in a real-world sample than previously reported, but still relatively frequent — affecting nearly 1 in 10 hypertensive patients.

Through their analysis, investigators also learned that patients with well-managed aRH were more likely to be treated with a commonplace medication called mineralocorticoid receptor antagonist, or MRA. These MRA treatments were used in 34% of patients with controlled aRH, but only 11% of patients with uncontrolled aRH.

Study findings were based on a unique design, which used clinically generated data from the electronic health records of three large, geographically diverse healthcare organizations. Of the 2,420,468 patients analyzed in the study, 55% were hypertensive. Of these hypertension patients, 8.5%, or 113,992 individuals, met criteria for aRH.

According to Ebinger, treating aRH can be just as tricky as diagnosing it. In fact, the “apparent” in apparent resistant hypertension stems from the fact that before diagnosis, medical professionals must first rule out other potential reasons for a patient’s blood pressure to be high.

These reasons might include medication non-adherence, inappropriate medication selection, or artificially elevated blood pressure in the doctor’s office — known as “white coat hypertension.”

Treating patients with complex cardiac issues like aRH is at the heart of Cedars-Sinai’s expertise.

The Smidt Heart Institute was recently awarded the American Heart Association’s Comprehensive Hypertension Center Certification, recognizing the institute’s commitment to following proven, research-based treatment guidelines to care for people with complex or difficult-to-treat hypertension.

Sources:

Joseph E. Ebinger, Ty J. Gluckman, Jose Magraner, Shih Ting Chiu, Deanna Rider, Chelsey Thomas, Sandeep R. Das, P. Michael Ho, Satya Shreenivas, Steven Bradley. Characterization of Individuals With Apparent Resistant Hypertension Using Contemporary Guidelines: Insights From CV-QUIC. Hypertension, 2023; DOI: 10.1161/HYPERTENSIONAHA.123.20894

Cedars-Sinai Medical Center. (2023, June 26). Novel study deepens knowledge of treatment-resistant hypertension. ScienceDaily. Retrieved June 27, 2023 from www.sciencedaily.com/releases/2023/06/230626164131.htm

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