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

摘要 非裔美国人（AAs）高血压患病率高， 与白人相比，患心血管疾病的风险更高。明显耐药 高血压（aTRH）是一种重度高血压，定义为需要≥ 4种抗高血压药物 控制血压（BP）。据估计，900万美国成年人 aTRH。考虑到排除假耐药所需的严格临床检查，因此， 诊断真正的TRH，TRH的人群患病率尚不清楚。我们建议一个辅助部队 杰克逊心脏研究（JHS）是一项大型的AA成人前瞻性队列研究（n= 5，306）， 将用aTRH深度表型参与者，排除假抗性（即，不准确的诊所 BP测量、存在白色大衣效应、次优抗高血压治疗，以及 药物依从性差）和高血压的次要原因（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设置， 拟议的研究，因为它包括了大量的AA人群， 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， 这将有助于筛选和招募我们辅助研究的参与者。基于 根据第四次JHS考试期间收集的数据，我们将确定400名aTRH参与者， 200例治疗反应对照。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，以检测白色被毛 降压药物和代谢产物的效果和尿液分析，以评估药物依从性。 此外，aTRH受试者将与治疗反应对照组进行比较， 高血压的次要原因和生活方式因素。研究结果的临床翻译 将由一个共同撰写《美国心脏》的外部专家小组推动 协会2018年关于顽固性高血压的科学声明。总的来说，诊断和 TRH的治疗受到我们对假耐药和其他因素的理解的限制 潜在的促甲状腺激素释放激素这项拟议的研究迫切需要更有效地诊断和 更好地治疗非裔美国人的严重高血压。

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.