Characteristics and Predictors of Apparent Treatment-Resistant Hypertension in Real-World Populations Using Electronic Health Record-Based Data.
Characteristics and Predictors of Apparent Treatment-Resistant Hypertension in Real-World Populations Using Electronic Health Record-Based Data.
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使用基于电子健康记录的数据，现实世界人群中明显难治性高血压的特征和预测因素。
DOI：
10.1093/ajh/hpad084
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发表时间：
2024
影响因子：
3.2
通讯作者：
McDonough,CaitrinW
中科院分区：
文献类型：
--
作者：
Jafari,Eissa;Cooper-DeHoff,RhondaM;Effron,MarkB;Hogan,WilliamR;McDonough,CaitrinW
研究背景表观治疗难治性高血压（aTRH）是指使用≥3种降压药治疗后血压仍不受控制或使用≥4种降压药治疗后血压仍受控制。与控制性高血压（HTN）患者相比，aTRH患者发生不良心血管结局的风险更高。虽然有关于aTRH的患病率，特征和预测因素的先前报告，但这些报告广泛来自较小的数据集，随机对照试验或封闭的医疗保健系统。方法我们从2个大型电子健康记录数据库中提取了1/1/2015-12/31/2018期间由ICD-9和ICD-10代码定义的HTN患者：OneFlorida Data Trust（n= 223，384）和Research Action for Health Network（REACHnet）（n= 175，229）。我们应用我们先前验证的aTRH和稳定对照HTN可计算表型算法，并进行单变量和多变量分析，以确定这些人群中aTRH的患病率，特征和预测因子。与稳定控制的HTN患者相比，这两个人群中患有aTRH的黑人患者比例显著较高。两个人群中的aTRH具有相似的显著预测因子，包括黑人、糖尿病、心力衰竭、慢性肾病、心脏肥大和较高的体重指数。在这两个人群中，aTRH与类似的合并症显着相关，当与稳定的控制HTN. CONCLUSIONSNIn 2大，不同的现实世界的人群相比，我们观察到类似的合并症和预测因子的aTRH作为先前的研究。在未来，这些结果可能会被用来提高医疗保健专业人员的aTRH预测因子和相关的合并症的理解。
BACKGROUNDApparent treatment-resistant hypertension (aTRH) is defined as uncontrolled blood pressure (BP) despite using ≥3 antihypertensive classes or controlled BP while using ≥4 antihypertensive classes. Patients with aTRH have a higher risk for adverse cardiovascular outcomes compared with patients with controlled hypertension (HTN). Although there have been prior reports on the prevalence, characteristics, and predictors of aTRH, these have been broadly derived from smaller datasets, randomized controlled trials, or closed healthcare systems.METHODSWe extracted patients with HTN defined by ICD-9 and ICD-10 codes during 1/1/2015–12/31/2018, from 2 large electronic health record databases: the OneFlorida Data Trust (n= 223,384) and Research Action for Health Network (REACHnet) (n= 175,229). We applied our previously validated aTRH and stable controlled HTN computable phenotype algorithms and performed univariate and multivariate analyses to identify the prevalence, characteristics, and predictors of aTRH in these populations.RESULTSThe prevalence of aTRH among patients with HTN in OneFlorida (16.7%) and REACHnet (11.3%) was similar to prior reports. Both populations had a significantly higher proportion of Black patients with aTRH compared with those with stable controlled HTN. aTRH in both populations shared similar significant predictors, including Black race, diabetes, heart failure, chronic kidney disease, cardiomegaly, and higher body mass index. In both populations, aTRH was significantly associated with similar comorbidities, when compared with stable controlled HTN.CONCLUSIONSIn 2 large, diverse real-world populations, we observed similar comorbidities and predictors of aTRH as prior studies. In the future, these results may be used to improve healthcare professionals’ understanding of aTRH predictors and associated comorbidities.