Refractory hypertension: determination of prevalence, risk factors, and comorbidities in a large, population-based cohort.
Refractory hypertension: determination of prevalence, risk factors, and comorbidities in a large, population-based cohort.
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DOI：
10.1161/hypertensionaha.113.02026
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发表时间：
2014-03
期刊：
影响因子：
--
通讯作者：
Muntner P
中科院分区：
文献类型：
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作者：
Calhoun DA;Booth JN 3rd;Oparil S;Irvin MR;Shimbo D;Lackland DT;Howard G;Safford MM;Muntner P
难治性高血压是抗高血压治疗失败的极端表型。卒中的地理和种族差异的原因（REGARDS）研究的参与者，一个大型的（n= 30，239），基于人群的队列进行了评估，以确定难治性高血压和相关的心血管危险因素和合并症的患病率。难治性高血压定义为≥ 5种降压药物治疗后血压不受控制（收缩压/舒张压≥ 140/90 mm Hg）。顽固性高血压受试者（≥ 3个降压药物类别的收缩压/舒张压≥140/90 mm Hg或≥ 4个降压药物类别的收缩压/舒张压<140/90 mm Hg）和所有接受治疗的高血压受试者作为对照组。在接受抗高血压治疗的14，809名REGARDS参与者中，78名（0.5%）患有难治性高血压。难治性高血压的患病率在患有难治性高血压的参与者中为3.6%（n= 2，144），在使用5种或更多种降压药物的参与者中为41.7%。在所有高血压参与者中，非洲裔美国人种族、男性、居住在中风带或带扣、较高的体重指数、较低的心率、估计的肾小球滤过率降低、蛋白尿、糖尿病以及中风和冠心病病史与难治性高血压相关。与难治性高血压相比，非裔美国人（3.00，95% CI 1.68 - 5.37）、蛋白尿（2.22，95% CI 1.40 - 3.52）和糖尿病（2.09，95% CI 1.32 - 3.31）患者的难治性高血压患病率增加。与对照组相比，难治性高血压参与者中冠心病和卒中的中位10年Fragrance风险较高。这些数据表明，虽然顽固性高血压在接受治疗的高血压患者中相对常见，但真正的降压治疗失败是罕见的。
Refractory hypertension is an extreme phenotype of antihypertensive treatment failure. Participants in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study, a large (n=30,239), population-based cohort were evaluated to determine the prevalence of refractory hypertension and associated cardiovascular risk factors and comorbidities. Refractory hypertension was defined as uncontrolled blood pressure (systolic/diastolic ≥ 140/90 mm Hg) on ≥ 5 antihypertensive drug classes. Participants with resistant hypertension (systolic/diastolic ≥140/90 mm Hg on ≥ 3 or<140/90 mm Hg on ≥ 4 antihypertensive classes) and all treated hypertensive participants served as comparator groups. Of 14,809 REGARDS participants receiving antihypertensive treatment, 78 (0.5%) had refractory hypertension. The prevalence of refractory hypertension was 3.6% among participants with resistant hypertension(n=2,144) and 41.7% among participants on 5 or more antihypertensive drug classes. Among all hypertensive participants, African American race, male gender, living in the stroke belt or buckle, higher body mass index, lower heart rate, reduced estimated glomerular filtration rate, albuminuria, diabetes and history of stroke and coronary heart disease were associated with refractory hypertension. Compared to resistant hypertension, prevalence ratios for refractory hypertension were increased for African Americans (3.00, 95% CI 1.68 – 5.37) and those with albuminuria (2.22, 95% CI 1.40 – 3.52) and diabetes (2.09, 95% CI 1.32 – 3.31). The median 10-year Framingham risk for coronary heart disease and stroke was higher among participants with refractory hypertension compared to either comparator group. These data indicate that while resistant hypertension is relatively common among treated hypertensive patients, true antihypertensive treatment failure is rare.