Prevalence of Apparent Treatment-Resistant Hypertension in the United States According to the 2017 High Blood Pressure Guideline

Kershaw V. Patel, Xilong Li, Nitin Kondamudi, Muthiah Vaduganathan, Beverley A Huet, Gregg C. Fonarow, Wanpen Vongpatanasin, Ambarish Pandey

Research output: Contribution to journalArticle

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Abstract

Objective: To evaluate the prevalence of apparent treatment-resistant hypertension (aTR-hypertension)in US adults with treated hypertension by using the nationally representative National Health and Nutrition Examination Survey (NHANES). Patients and Methods: Nonpregnant US adults older than 20 years with a self-reported history of treated hypertension who had blood pressure measured in NHANES cycles 2007 to 2014 were included in this study. Study participants were stratified into 4 groups according to average blood pressure and antihypertensive medication use: well-controlled hypertension, undertreated hypertension, aTR-hypertension by the 2017 guideline, and aTR-hypertension by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)guideline. National Health and Nutrition Examination Survey sample weights were used to estimate the national prevalence. Results: From 2007 to 2014, 5512 participants with treated hypertension representing 46.7 million people nationally were included. Compared with JNC 7 guideline criteria, application of the 2017 high blood pressure guideline criteria increased the prevalence of aTR-hypertension in US adults with treated hypertension from 12.0% to 15.95%, identifying an additional 1.85 million individuals with aTR-hypertension nationally. Individuals newly reclassified as having aTR-hypertension were younger. However, the prevalence of thiazide diuretic use remained less than 70%, and that of mineralocorticoid antagonist use remained less than 10% regardless of the guideline definition. Conclusion: On the basis of the 2017 high blood pressure guideline, the prevalence of aTR-hypertension is 15.95% in US adults with treated hypertension. This represents an absolute increase of 4% (1.85 million additional individuals nationally)compared with the JNC 7 guideline definition, with a consistent increase across all subpopulations with treated hypertension.

Original languageEnglish (US)
Pages (from-to)776-782
Number of pages7
JournalMayo Clinic Proceedings
Volume94
Issue number5
DOIs
StatePublished - May 1 2019

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Guidelines
Hypertension
Therapeutics
Nutrition Surveys
Blood Pressure
Mineralocorticoid Receptor Antagonists
Sodium Chloride Symporter Inhibitors
Antihypertensive Agents
Weights and Measures

ASJC Scopus subject areas

  • Medicine(all)

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Prevalence of Apparent Treatment-Resistant Hypertension in the United States According to the 2017 High Blood Pressure Guideline. / Patel, Kershaw V.; Li, Xilong; Kondamudi, Nitin; Vaduganathan, Muthiah; Huet, Beverley A; Fonarow, Gregg C.; Vongpatanasin, Wanpen; Pandey, Ambarish.

In: Mayo Clinic Proceedings, Vol. 94, No. 5, 01.05.2019, p. 776-782.

Research output: Contribution to journalArticle

Patel, Kershaw V. ; Li, Xilong ; Kondamudi, Nitin ; Vaduganathan, Muthiah ; Huet, Beverley A ; Fonarow, Gregg C. ; Vongpatanasin, Wanpen ; Pandey, Ambarish. / Prevalence of Apparent Treatment-Resistant Hypertension in the United States According to the 2017 High Blood Pressure Guideline. In: Mayo Clinic Proceedings. 2019 ; Vol. 94, No. 5. pp. 776-782.
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abstract = "Objective: To evaluate the prevalence of apparent treatment-resistant hypertension (aTR-hypertension)in US adults with treated hypertension by using the nationally representative National Health and Nutrition Examination Survey (NHANES). Patients and Methods: Nonpregnant US adults older than 20 years with a self-reported history of treated hypertension who had blood pressure measured in NHANES cycles 2007 to 2014 were included in this study. Study participants were stratified into 4 groups according to average blood pressure and antihypertensive medication use: well-controlled hypertension, undertreated hypertension, aTR-hypertension by the 2017 guideline, and aTR-hypertension by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)guideline. National Health and Nutrition Examination Survey sample weights were used to estimate the national prevalence. Results: From 2007 to 2014, 5512 participants with treated hypertension representing 46.7 million people nationally were included. Compared with JNC 7 guideline criteria, application of the 2017 high blood pressure guideline criteria increased the prevalence of aTR-hypertension in US adults with treated hypertension from 12.0{\%} to 15.95{\%}, identifying an additional 1.85 million individuals with aTR-hypertension nationally. Individuals newly reclassified as having aTR-hypertension were younger. However, the prevalence of thiazide diuretic use remained less than 70{\%}, and that of mineralocorticoid antagonist use remained less than 10{\%} regardless of the guideline definition. Conclusion: On the basis of the 2017 high blood pressure guideline, the prevalence of aTR-hypertension is 15.95{\%} in US adults with treated hypertension. This represents an absolute increase of 4{\%} (1.85 million additional individuals nationally)compared with the JNC 7 guideline definition, with a consistent increase across all subpopulations with treated hypertension.",
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AU - Patel, Kershaw V.

AU - Li, Xilong

AU - Kondamudi, Nitin

AU - Vaduganathan, Muthiah

AU - Huet, Beverley A

AU - Fonarow, Gregg C.

AU - Vongpatanasin, Wanpen

AU - Pandey, Ambarish

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N2 - Objective: To evaluate the prevalence of apparent treatment-resistant hypertension (aTR-hypertension)in US adults with treated hypertension by using the nationally representative National Health and Nutrition Examination Survey (NHANES). Patients and Methods: Nonpregnant US adults older than 20 years with a self-reported history of treated hypertension who had blood pressure measured in NHANES cycles 2007 to 2014 were included in this study. Study participants were stratified into 4 groups according to average blood pressure and antihypertensive medication use: well-controlled hypertension, undertreated hypertension, aTR-hypertension by the 2017 guideline, and aTR-hypertension by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)guideline. National Health and Nutrition Examination Survey sample weights were used to estimate the national prevalence. Results: From 2007 to 2014, 5512 participants with treated hypertension representing 46.7 million people nationally were included. Compared with JNC 7 guideline criteria, application of the 2017 high blood pressure guideline criteria increased the prevalence of aTR-hypertension in US adults with treated hypertension from 12.0% to 15.95%, identifying an additional 1.85 million individuals with aTR-hypertension nationally. Individuals newly reclassified as having aTR-hypertension were younger. However, the prevalence of thiazide diuretic use remained less than 70%, and that of mineralocorticoid antagonist use remained less than 10% regardless of the guideline definition. Conclusion: On the basis of the 2017 high blood pressure guideline, the prevalence of aTR-hypertension is 15.95% in US adults with treated hypertension. This represents an absolute increase of 4% (1.85 million additional individuals nationally)compared with the JNC 7 guideline definition, with a consistent increase across all subpopulations with treated hypertension.

AB - Objective: To evaluate the prevalence of apparent treatment-resistant hypertension (aTR-hypertension)in US adults with treated hypertension by using the nationally representative National Health and Nutrition Examination Survey (NHANES). Patients and Methods: Nonpregnant US adults older than 20 years with a self-reported history of treated hypertension who had blood pressure measured in NHANES cycles 2007 to 2014 were included in this study. Study participants were stratified into 4 groups according to average blood pressure and antihypertensive medication use: well-controlled hypertension, undertreated hypertension, aTR-hypertension by the 2017 guideline, and aTR-hypertension by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)guideline. National Health and Nutrition Examination Survey sample weights were used to estimate the national prevalence. Results: From 2007 to 2014, 5512 participants with treated hypertension representing 46.7 million people nationally were included. Compared with JNC 7 guideline criteria, application of the 2017 high blood pressure guideline criteria increased the prevalence of aTR-hypertension in US adults with treated hypertension from 12.0% to 15.95%, identifying an additional 1.85 million individuals with aTR-hypertension nationally. Individuals newly reclassified as having aTR-hypertension were younger. However, the prevalence of thiazide diuretic use remained less than 70%, and that of mineralocorticoid antagonist use remained less than 10% regardless of the guideline definition. Conclusion: On the basis of the 2017 high blood pressure guideline, the prevalence of aTR-hypertension is 15.95% in US adults with treated hypertension. This represents an absolute increase of 4% (1.85 million additional individuals nationally)compared with the JNC 7 guideline definition, with a consistent increase across all subpopulations with treated hypertension.

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