Prevalence of Apparent Treatment-Resistant Hypertension in the United States: Comparison of the 2008 and 2018 American Heart Association Scientific Statements on Resistant Hypertension
Prevalence of Apparent Treatment-Resistant Hypertension in the United States: Comparison of the 2008 and 2018 American Heart Association Scientific Statements on Resistant Hypertension
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DOI：
10.1161/hypertensionaha.118.12191
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发表时间：
2019-02-01
期刊：
影响因子：
8.3
通讯作者：
Muntner, Paul
中科院分区：
文献类型：
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作者：
Carey, Robert M.;Sakhuja, Swati;Muntner, Paul
2018年，美国心脏协会发表了一份关于顽固性高血压的科学声明。我们比较了2018年和2008年美国心脏协会科学声明中定义的美国成年人中明显治疗难治性高血压（aTRH）的患病率，使用了2009年至2014年全国健康与营养检查调查中服用降压药的4158名高血压患者的数据。测量血压（BP） 3次，并通过药瓶审查确定降压药物类别。在两份科学声明中，aTRH被定义为无论血压水平如何，服用3类降压药或服用4类降压药时血压不受控制。未控制的血压在2008年科学声明中定义为收缩压/舒张压140/90 mmHg（糖尿病或慢性肾病患者为130/80 mmHg），在2018年科学声明中定义为收缩压/舒张压130/80 mmHg（收缩压130 mmHg仅适用于65岁低风险成年人）。根据2008年和2018年科学声明的定义，aTRH的患病率分别为17.7%和19.7% （=2.0%;95% CI, 1.5%-2.7%）。根据2018年的科学声明，总体而言，1030万美国成年人患有aTRH。最常见的3种药物组合包括血管紧张素转换酶抑制剂、受体阻滞剂和噻嗪类利尿剂。根据2018年的定义，3.2%的aTRH美国成年人正在服用噻嗪类利尿剂（氯噻酮或吲达帕胺），9.0%的人正在服用矿皮质激素受体阻滞剂（螺内酯或依普利酮）。总之，使用2018年的定义，与2008年的难治性高血压科学声明相比，aTRH的患病率仅略高。
In 2018, the American Heart Association published a Scientific Statement on resistant hypertension. We compared the prevalence of apparent treatment-resistant hypertension (aTRH) among US adults as defined in the 2018 and 2008 American Heart Association Scientific Statements using data from 4158 participants with hypertension, taking antihypertensive medication in the 2009 to 2014 National Health and Nutrition Examination Survey. Blood pressure (BP) was measured 3 times, and antihypertensive medication classes were identified through a pill bottle review. In both Scientific Statements, aTRH was defined as uncontrolled BP while taking 3 classes of antihypertensive medication or taking 4 classes of antihypertensive medication regardless of BP level. Uncontrolled BP was defined as systolic/diastolic BP 140/90 mmHg (130/80 mmHg for those with diabetes mellitus or chronic kidney disease) in the 2008 Scientific Statement and systolic/diastolic BP 130/80 mmHg (systolic BP 130 mmHg only for low-risk adults 65 years of age) in the 2018 Scientific Statement. The prevalence of aTRH was 17.7% and 19.7% according to the 2008 and 2018 Scientific Statement definitions, respectively (=2.0%; 95% CI, 1.5%-2.7%). Overall, 10.3 million US adults had aTRH according to the 2018 Scientific Statement. The most common 3-drug combination taken included an angiotensin-converting enzyme inhibitor, -blocker, and thiazide diuretic. Using the 2018 definition, 3.2% of US adults with aTRH were taking a thiazide-like diuretic (chlorthalidone or indapamide), and 9.0% were taking a mineralocorticoid receptor blocker (spironolactone or eplerenone). In conclusion, the prevalence of aTRH is only modestly higher using the definition in the 2018 versus 2008 resistant hypertension Scientific Statement.