Determining true versus apparent treatment-resistant hypertension among African Americans in the Jackson Heart Study

摘要 非裔美国人(AA)高血压患病率高，并遭受不成比例的 与白人相比，他们患心血管疾病的风险更高。表观抗药性 高血压(Atrh)是一种严重的高血压，定义为需要≥4抗高血压。 控制血压(BP)的药物。据估计，有900万美国成年人患有 ATRH。考虑到需要严格的临床检查来排除假耐药，因此， 诊断真实的TRH，TRH的人群患病率尚不清楚。我们提出了一项附属的 杰克逊心脏研究(JHS)，一大批AA成年人(n=5,306)的前瞻性队列研究 将深度表型参与者与aTRH，排除假耐药(即，不准确的临床 血压测量，白大衣效应的存在，不理想的降压治疗，以及 服药依从性差)和高血压的继发性原因(即，原发性醛固酮增多症， 阻塞性睡眠呼吸暂停和肾脏疾病)。JHS提供了一个高度可行的环境 拟议的研究，因为它包括了大量的AAA人群，这些AAA的患病率很高 高血压和广泛的数据收集，作为即将到来的第四次家长研究访问的一部分， 这将为我们的辅助研究筛选和招募参与者提供便利。基座 根据第四次JHS考试期间收集的数据，我们将确定400名参与者患有aTRH和 200名治疗反应对照。这些参与者将接受TRH的临床评估。 包括评估现有的动态血压监测(ABPM)数据，以检测白大衣 评价用药依从性的降压药物和代谢物的疗效和尿液分析。 此外，在以下方面，接受aTRH的参与者将与治疗反应的对照组进行比较 高血压的继发原因和生活方式因素。研究结果的临床翻译 将由与人合著《美国心脏》的外部专家小组提供协助 协会2018年顽固性高血压科学声明。总体而言，诊断和 TRH的治疗受限于我们对假耐药和其他因素的理解 潜在的aTRH。迫切需要拟议的研究来更有效地诊断和 更好地治疗非裔美国人中这种严重的高血压。

Abstract African Americans (AAs) have a high prevalence of hypertension and suffer a disproportionately high risk for cardiovascular disease compared to whites. Apparent treatment-resistant hypertension (aTRH) is a severe form of hypertension defined as requiring ≥ 4 antihypertensive medications to achieve blood pressure (BP) control. An estimated 9 million US adults have aTRH. Given the rigorous clinical work-up needed to rule out pseudoresistance and therefore, diagnose true TRH, the population prevalence of TRH is not known. We propose an ancillary study to the Jackson Heart Study (JHS), a large prospective cohort of AA adults (n=5,306) that will deeply phenotype participants with aTRH, ruling out pseudoresistance (i.e., inaccurate clinic BP measurement, presence of a white coat effect, suboptimal antihypertensive therapy, and poor medication adherence) and secondary causes of hypertension (i.e., primary aldosteronism, obstructive sleep apnea, and kidney disease). The JHS provides a highly feasible setting for the proposed study as it includes a large population of AAs with a high prevalence of hypertension and extensive data collection as part of an upcoming fourth parent study visit, which will facilitate the screening and recruitment of participants for our ancillary study. Based on data collected during the fourth JHS exam, we will identify 400 participants with aTRH and 200 treatment-responsive controls. These participants will undergo a clinical evaluation for TRH including assessment of existing ambulatory BP monitoring (ABPM) data to detect white coat effect and urinalysis of antihypertensive drugs and metabolites to assess medication adherence. Also, participants with aTRH will be compared to treatment responsive controls with respect to secondary causes of hypertension and lifestyle factors. Clinical translation of the study findings will be facilitated by an external panel of experts who co-authored the American Heart Association 2018 Scientific Statement on Resistant Hypertension. Overall, the diagnosis and treatment of TRH is limited by our understanding of pseudoresistance and other factors underlying aTRH. The proposed study is urgently needed to more efficiently diagnose and better treat this severe form of hypertension among African Americans.