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Proceedings from Duke resistant hypertension think tank
Sreekanth Vemulapalli1, Jamy Ard2, George L Bakris3
1Division of Cardiology, Duke University Medical Center, Durham, NC.
American Heart Journal
|June 4, 2014
Summary
Apparent treatment-resistant hypertension (aTRH) affects 10-15% of hypertensive patients. Further research and specific therapeutic pathways are needed to improve cardiovascular outcomes for these individuals.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Trials
Background:
- Apparent treatment-resistant hypertension (aTRH) is defined as uncontrolled blood pressure (BP) despite ≥3 antihypertensive medications.
- Growing scientific interest necessitates improved understanding and management strategies for aTRH patients.
- Current prevalence estimates suggest aTRH impacts 10-15% of hypertensive individuals in select populations.
Framework:
- A multistakeholder think tank convened to discuss current knowledge and future research directions for aTRH.
- Proposed development of an "aTRH" label for pharmacologic and device therapies.
- Emphasis on treatment pathways involving adding new therapies to existing regimens.
Implementation:
- Future large-scale observational studies are crucial for elucidating aTRH risk factors.
- Pharmacologic and device therapies require clear developmental pathways for FDA approval.
- Standardized processes for patient selection and post-approval registries are needed for device trials.
Implications:
- Demonstrating adequate BP lowering may suffice for FDA approval of aTRH therapies.
- Assessment of quality of life and cardiovascular outcomes is desirable for coverage decisions.
- Multidisciplinary hypertension team evaluation is recommended for optimal patient management before advanced therapies.
