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Langford AT, Akinyelure OP, Moore TL, Howard G, Min YI, Hillegass WB, Bress AP, Tajeu GS, Butler M, Jaeger BC, Yano Y, Shimbo D, Ogedegbe G, Calhoun D, Booth JN, Muntner P. Underutilization of Treatment for Black Adults With Apparent Treatment-Resistant Hypertension: JHS and the REGARDS Study. Hypertension 2020; 76:1600-1607. [PMID: 32924633 PMCID: PMC7685176 DOI: 10.1161/hypertensionaha.120.14836] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 07/20/2020] [Indexed: 01/26/2023]
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.
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Affiliation(s)
- Aisha T Langford
- From the Department of Population Health, NYU School of Medicine (A.T.L., M.B., G.O.)
- Departments of Epidemiology (O.P.A., T.L.M., J.N.B., P.M.), University of Alabama at Birmingham
- Departments of Biostatistics (G.H., B.C.J.), University of Alabama at Birmingham
- Departments of Medicine (D.C.), University of Alabama at Birmingham
- Departments of Data Science (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Departments of Medicine (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (G.S.T.)
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (Y.Y.)
- and Department of Medicine, Columbia Hypertension Center, Columbia University Medical Center, New York, NY (D.S.)
- CTI Clinical Trials and Consulting Services, Inc., Covington, KY (J.N.B.)
| | - Oluwasegun P Akinyelure
- From the Department of Population Health, NYU School of Medicine (A.T.L., M.B., G.O.)
- Departments of Epidemiology (O.P.A., T.L.M., J.N.B., P.M.), University of Alabama at Birmingham
- Departments of Biostatistics (G.H., B.C.J.), University of Alabama at Birmingham
- Departments of Medicine (D.C.), University of Alabama at Birmingham
- Departments of Data Science (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Departments of Medicine (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (G.S.T.)
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (Y.Y.)
- and Department of Medicine, Columbia Hypertension Center, Columbia University Medical Center, New York, NY (D.S.)
- CTI Clinical Trials and Consulting Services, Inc., Covington, KY (J.N.B.)
| | - Tony L Moore
- From the Department of Population Health, NYU School of Medicine (A.T.L., M.B., G.O.)
- Departments of Epidemiology (O.P.A., T.L.M., J.N.B., P.M.), University of Alabama at Birmingham
- Departments of Biostatistics (G.H., B.C.J.), University of Alabama at Birmingham
- Departments of Medicine (D.C.), University of Alabama at Birmingham
- Departments of Data Science (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Departments of Medicine (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (G.S.T.)
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (Y.Y.)
- and Department of Medicine, Columbia Hypertension Center, Columbia University Medical Center, New York, NY (D.S.)
- CTI Clinical Trials and Consulting Services, Inc., Covington, KY (J.N.B.)
| | - George Howard
- From the Department of Population Health, NYU School of Medicine (A.T.L., M.B., G.O.)
- Departments of Epidemiology (O.P.A., T.L.M., J.N.B., P.M.), University of Alabama at Birmingham
- Departments of Biostatistics (G.H., B.C.J.), University of Alabama at Birmingham
- Departments of Medicine (D.C.), University of Alabama at Birmingham
- Departments of Data Science (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Departments of Medicine (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (G.S.T.)
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (Y.Y.)
- and Department of Medicine, Columbia Hypertension Center, Columbia University Medical Center, New York, NY (D.S.)
- CTI Clinical Trials and Consulting Services, Inc., Covington, KY (J.N.B.)
| | - Yuan-I Min
- From the Department of Population Health, NYU School of Medicine (A.T.L., M.B., G.O.)
- Departments of Epidemiology (O.P.A., T.L.M., J.N.B., P.M.), University of Alabama at Birmingham
- Departments of Biostatistics (G.H., B.C.J.), University of Alabama at Birmingham
- Departments of Medicine (D.C.), University of Alabama at Birmingham
- Departments of Data Science (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Departments of Medicine (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (G.S.T.)
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (Y.Y.)
- and Department of Medicine, Columbia Hypertension Center, Columbia University Medical Center, New York, NY (D.S.)
- CTI Clinical Trials and Consulting Services, Inc., Covington, KY (J.N.B.)
| | - William B Hillegass
- From the Department of Population Health, NYU School of Medicine (A.T.L., M.B., G.O.)
- Departments of Epidemiology (O.P.A., T.L.M., J.N.B., P.M.), University of Alabama at Birmingham
- Departments of Biostatistics (G.H., B.C.J.), University of Alabama at Birmingham
- Departments of Medicine (D.C.), University of Alabama at Birmingham
- Departments of Data Science (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Departments of Medicine (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (G.S.T.)
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (Y.Y.)
- and Department of Medicine, Columbia Hypertension Center, Columbia University Medical Center, New York, NY (D.S.)
- CTI Clinical Trials and Consulting Services, Inc., Covington, KY (J.N.B.)
| | - Adam P Bress
- From the Department of Population Health, NYU School of Medicine (A.T.L., M.B., G.O.)
- Departments of Epidemiology (O.P.A., T.L.M., J.N.B., P.M.), University of Alabama at Birmingham
- Departments of Biostatistics (G.H., B.C.J.), University of Alabama at Birmingham
- Departments of Medicine (D.C.), University of Alabama at Birmingham
- Departments of Data Science (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Departments of Medicine (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (G.S.T.)
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (Y.Y.)
- and Department of Medicine, Columbia Hypertension Center, Columbia University Medical Center, New York, NY (D.S.)
- CTI Clinical Trials and Consulting Services, Inc., Covington, KY (J.N.B.)
| | - Gabriel S Tajeu
- From the Department of Population Health, NYU School of Medicine (A.T.L., M.B., G.O.)
- Departments of Epidemiology (O.P.A., T.L.M., J.N.B., P.M.), University of Alabama at Birmingham
- Departments of Biostatistics (G.H., B.C.J.), University of Alabama at Birmingham
- Departments of Medicine (D.C.), University of Alabama at Birmingham
- Departments of Data Science (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Departments of Medicine (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (G.S.T.)
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (Y.Y.)
- and Department of Medicine, Columbia Hypertension Center, Columbia University Medical Center, New York, NY (D.S.)
- CTI Clinical Trials and Consulting Services, Inc., Covington, KY (J.N.B.)
| | - Mark Butler
- From the Department of Population Health, NYU School of Medicine (A.T.L., M.B., G.O.)
- Departments of Epidemiology (O.P.A., T.L.M., J.N.B., P.M.), University of Alabama at Birmingham
- Departments of Biostatistics (G.H., B.C.J.), University of Alabama at Birmingham
- Departments of Medicine (D.C.), University of Alabama at Birmingham
- Departments of Data Science (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Departments of Medicine (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (G.S.T.)
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (Y.Y.)
- and Department of Medicine, Columbia Hypertension Center, Columbia University Medical Center, New York, NY (D.S.)
- CTI Clinical Trials and Consulting Services, Inc., Covington, KY (J.N.B.)
| | - Byron C Jaeger
- From the Department of Population Health, NYU School of Medicine (A.T.L., M.B., G.O.)
- Departments of Epidemiology (O.P.A., T.L.M., J.N.B., P.M.), University of Alabama at Birmingham
- Departments of Biostatistics (G.H., B.C.J.), University of Alabama at Birmingham
- Departments of Medicine (D.C.), University of Alabama at Birmingham
- Departments of Data Science (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Departments of Medicine (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (G.S.T.)
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (Y.Y.)
- and Department of Medicine, Columbia Hypertension Center, Columbia University Medical Center, New York, NY (D.S.)
- CTI Clinical Trials and Consulting Services, Inc., Covington, KY (J.N.B.)
| | - Yuichiro Yano
- From the Department of Population Health, NYU School of Medicine (A.T.L., M.B., G.O.)
- Departments of Epidemiology (O.P.A., T.L.M., J.N.B., P.M.), University of Alabama at Birmingham
- Departments of Biostatistics (G.H., B.C.J.), University of Alabama at Birmingham
- Departments of Medicine (D.C.), University of Alabama at Birmingham
- Departments of Data Science (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Departments of Medicine (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (G.S.T.)
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (Y.Y.)
- and Department of Medicine, Columbia Hypertension Center, Columbia University Medical Center, New York, NY (D.S.)
- CTI Clinical Trials and Consulting Services, Inc., Covington, KY (J.N.B.)
| | - Daichi Shimbo
- From the Department of Population Health, NYU School of Medicine (A.T.L., M.B., G.O.)
- Departments of Epidemiology (O.P.A., T.L.M., J.N.B., P.M.), University of Alabama at Birmingham
- Departments of Biostatistics (G.H., B.C.J.), University of Alabama at Birmingham
- Departments of Medicine (D.C.), University of Alabama at Birmingham
- Departments of Data Science (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Departments of Medicine (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (G.S.T.)
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (Y.Y.)
- and Department of Medicine, Columbia Hypertension Center, Columbia University Medical Center, New York, NY (D.S.)
- CTI Clinical Trials and Consulting Services, Inc., Covington, KY (J.N.B.)
| | - Gbenga Ogedegbe
- From the Department of Population Health, NYU School of Medicine (A.T.L., M.B., G.O.)
- Departments of Epidemiology (O.P.A., T.L.M., J.N.B., P.M.), University of Alabama at Birmingham
- Departments of Biostatistics (G.H., B.C.J.), University of Alabama at Birmingham
- Departments of Medicine (D.C.), University of Alabama at Birmingham
- Departments of Data Science (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Departments of Medicine (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (G.S.T.)
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (Y.Y.)
- and Department of Medicine, Columbia Hypertension Center, Columbia University Medical Center, New York, NY (D.S.)
- CTI Clinical Trials and Consulting Services, Inc., Covington, KY (J.N.B.)
| | - David Calhoun
- From the Department of Population Health, NYU School of Medicine (A.T.L., M.B., G.O.)
- Departments of Epidemiology (O.P.A., T.L.M., J.N.B., P.M.), University of Alabama at Birmingham
- Departments of Biostatistics (G.H., B.C.J.), University of Alabama at Birmingham
- Departments of Medicine (D.C.), University of Alabama at Birmingham
- Departments of Data Science (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Departments of Medicine (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (G.S.T.)
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (Y.Y.)
- and Department of Medicine, Columbia Hypertension Center, Columbia University Medical Center, New York, NY (D.S.)
- CTI Clinical Trials and Consulting Services, Inc., Covington, KY (J.N.B.)
| | - John N Booth
- From the Department of Population Health, NYU School of Medicine (A.T.L., M.B., G.O.)
- Departments of Epidemiology (O.P.A., T.L.M., J.N.B., P.M.), University of Alabama at Birmingham
- Departments of Biostatistics (G.H., B.C.J.), University of Alabama at Birmingham
- Departments of Medicine (D.C.), University of Alabama at Birmingham
- Departments of Data Science (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Departments of Medicine (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (G.S.T.)
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (Y.Y.)
- and Department of Medicine, Columbia Hypertension Center, Columbia University Medical Center, New York, NY (D.S.)
- CTI Clinical Trials and Consulting Services, Inc., Covington, KY (J.N.B.)
| | - Paul Muntner
- From the Department of Population Health, NYU School of Medicine (A.T.L., M.B., G.O.)
- Departments of Epidemiology (O.P.A., T.L.M., J.N.B., P.M.), University of Alabama at Birmingham
- Departments of Biostatistics (G.H., B.C.J.), University of Alabama at Birmingham
- Departments of Medicine (D.C.), University of Alabama at Birmingham
- Departments of Data Science (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Departments of Medicine (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (G.S.T.)
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (Y.Y.)
- and Department of Medicine, Columbia Hypertension Center, Columbia University Medical Center, New York, NY (D.S.)
- CTI Clinical Trials and Consulting Services, Inc., Covington, KY (J.N.B.)
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