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Underutilization of Treatment for Black Adults With Apparent Treatment-Resistant Hypertension: JHS and the REGARDS
Aisha T Langford1,2,3,4,5,6,7,8,9,10,11, Oluwasegun P Akinyelure1,2,3,4,5,6,7,8,9,10,11, Tony L Moore1,2,3,4,5,6,7,8,9,10,11
1From the Department of Population Health, NYU School of Medicine (A.T.L., M.B., G.O.).
Insights
Lifestyle and medication use are low in Black adults with apparent treatment-resistant hypertension (aTRH). Increased adherence to guidelines may improve cardiovascular health and reduce related deaths.
Area of Science:
- Cardiology
- Public Health
- Pharmacology
Background:
- Resistant hypertension (RH) significantly increases cardiovascular disease (CVD) risk.
- The 2018 AHA guidelines recommend lifestyle changes and specific medications for RH.
- Apparent treatment-resistant hypertension (aTRH) accounts for RH cases where pseudoresistance is possible.
Purpose of the Study:
- To assess the adoption of healthy lifestyle factors and recommended medications in US Black adults with aTRH.
- To identify gaps in evidence-based treatment for this population.
Main Methods:
- Pooled data from the Jackson Heart Study (JHS) and Reasons for Geographic and Racial Differences in Stroke (REGARDS) study.
- Included Black participants reporting antihypertensive medication use.
- Assessed lifestyle factors (smoking, alcohol, physical activity, BMI) and use of thiazide-like diuretics and mineralocorticoid receptor antagonists.
Main Results:
- 28.3% of participants on antihypertensives had aTRH.
- Only 14.5% met 3 ideal lifestyle factors, and 1.2% met 4.
- Use of thiazide-like diuretics was 5.9%, and mineralocorticoid receptor antagonists was 9.8%.
Conclusions:
- Healthy lifestyle factors and recommended medications are underutilized in Black adults with aTRH.
- Improving adherence to lifestyle recommendations and guideline-directed pharmacotherapy is crucial.
- This could significantly reduce CVD morbidity and mortality in US Black adults.
Abstract:
Resistant hypertension, defined as blood pressure levels above goal while taking ≥3 classes of antihypertensive medication or ≥4 classes regardless of blood pressure level, is associated with increased cardiovascular disease risk. The 2018 American Heart Association Scientific Statement on Resistant Hypertension recommends healthy lifestyle habits and thiazide-like diuretics and mineralocorticoid receptor antagonists for adults with resistant hypertension. The term apparent treatment-resistant hypertension (aTRH) is used when pseudoresistance cannot be excluded. We estimated the use of healthy lifestyle factors and recommended antihypertensive medication classes among US Black adults with aTRH. Data were pooled for Black participants in the JHS (Jackson Heart Study) in 2009 to 2013 (n=2496) and the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) in 2013 to 2016 (n=3786). Outcomes included lifestyle factors (not smoking, not consuming alcohol, ≥75 minutes of vigorous-intensity or ≥150 minutes of moderate or vigorous physical activity per week, and body mass index <25 kg/m2) and recommended antihypertensive medications (thiazide-like diuretics and mineralocorticoid receptor antagonists). Overall, 28.3% of participants who reported taking antihypertensive medication had aTRH. Among participants with aTRH, 14.5% and 1.2% had ideal levels of 3 and 4 of the lifestyle factors, respectively. Also, 5.9% of participants with aTRH reported taking a thiazide-like diuretic, and 9.8% reported taking a mineralocorticoid receptor antagonist. In conclusion, evidence-based lifestyle factors and recommended pharmacological treatment are underutilized in Black adults with aTRH. Increased use of lifestyle recommendations and antihypertensive medication classes specifically recommended for aTRH may improve blood pressure control and reduce cardiovascular disease-related morbidity and mortality among US Black adults. Graphic Abstract A graphic abstract is available for this article.