MSGID: 1:317/3 649a65f2   
   PID: hpt/lnx 1.9.0-cur 2019-01-08   
   TID: hpt/lnx 1.9.0-cur 2019-01-08   
    Novel study deepens knowledge of treatment-resistant hypertension    
      
     Date:   
         June 26, 2023   
     Source:   
         Cedars-Sinai Medical Center   
     Summary:   
         Novel research found that apparent resistant hypertension (aRH)   
         prevalence was lower in a real-world sample than previously   
         reported, but still relatively frequent -- affecting nearly 1 in   
         10 hypertensive patients.   
      
      
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   FULL STORY   
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   For many patients with hypertension -- an elevated blood pressure that   
   can lead to stroke or heart attack -- medication keeps the condition at   
   bay. But what happens when medication that physicians usually prescribe   
   doesn't work? Known as apparent resistant hypertension (aRH), this form   
   of high blood pressure requires more medication and medical management.   
      
   Novel research from investigators in the Smidt Heart Institute at   
   Cedars-Sinai, published today in the peer-reviewed journal Hypertension,   
   found that aRH prevalence was lower in a real-world sample than previously   
   reported, but still relatively frequent -- affecting nearly 1 in 10   
   hypertensive patients.   
      
   Through their analysis, investigators also learned that patients with   
   well- managed aRH were more likely to be treated with a commonplace   
   medication called mineralocorticoid receptor antagonist, or MRA. These   
   MRA treatments were used in 34% of patients with controlled aRH, but   
   only 11% of patients with uncontrolled aRH.   
      
   "Apparent resistant hypertension is more common than many would   
   anticipate," said Joseph Ebinger, MD, assistant professor of Cardiology   
   in the Smidt Heart Institute and corresponding author of the study. "We   
   also learned that within this high-risk population, there are large   
   differences in how providers treat high blood pressure, exemplifying a   
   need to standardize care."  Study findings were based on a unique design,   
   which used clinically generated data from the electronic health records   
   of three large, geographically diverse healthcare organizations. Of the   
   2,420,468 patients analyzed in the study, 55% were hypertensive. Of these   
   hypertension patients, 8.5%, or 113,992 individuals, met criteria for aRH.   
      
   According to Ebinger, treating aRH can be just as tricky as diagnosing it.   
      
   In fact, the "apparent" in apparent resistant hypertension stems from   
   the fact that before diagnosis, medical professionals must first rule   
   out other potential reasons for a patient's blood pressure to be high.   
      
   These reasons might include medication non-adherence, inappropriate   
   medication selection, or artificially elevated blood pressure in the   
   doctor's office - - known as "white coat hypertension."  "Large amounts of   
   data tell us that patients with aRH, compared to those with non-resistant   
   forms of hypertension, are at greatest risk for adverse cardiovascular   
   events," said Ebinger, director of Clinical Analytics in the Smidt Heart   
   Institute. "Identifying these patients and possible causes for their   
   elevated blood pressure is increasingly important."  The takeaway, Ebinger   
   says, is awareness -- for both medical professionals and patients. He   
   says providers should be mindful that if it's taking four or more   
   antihypertensive medications to control a patient's blood pressure,   
   they should consider evaluation for alternative causes of hypertension,   
   or refer patients to a specialist.   
      
   Similarly, patients should lean on their medical providers to help them   
   navigate the complex disease, including having a conversation around   
   strategies for remembering to take their medication and addressing   
   possible treatment side effects.   
      
   Treating patients with complex cardiac issues like aRH is at the heart   
   of Cedars-Sinai's expertise.   
      
   The Smidt Heart Institute was recently awarded the American Heart   
   Association's Comprehensive Hypertension Center Certification, recognizing   
   the institute's commitment to following proven, research-based treatment   
   guidelines to care for people with complex or difficult-to-treat   
   hypertension.   
      
   "This accreditation, coupled with our clinical and research expertise in   
   hypertensive diseases, serves as a mark of excellence," said Christine M.   
      
   Albert, MD, MPH, chair of the Department of Cardiology and the Lee   
   and Harold Kapelovitz Distinguished Chair in Cardiology. "These efforts   
   signal to patients, healthcare providers, and the community that the Smidt   
   Heart Institute is committed to delivering evidence-based, comprehensive   
   care for hypertension."  Funding: This work was supported in part by   
   Cedars-Sinai Medical Center and by the National Institutes of Health   
   grant K23-HL153888.   
      
       * RELATED_TOPICS   
             o Health_&_Medicine   
                   # Hypertension # Heart_Disease # Today's_Healthcare #   
                   Patient_Education_and_Counseling   
             o Mind_&_Brain   
                   # Stroke # Depression # Multiple_Sclerosis # Mental_Health   
       * RELATED_TERMS   
             o Hypertension o Scanning_electron_microscope o   
             Antibiotic_resistance o Nicotine o Doppler_effect o   
             Illusion_of_control o Adult_stem_cell o Epidemiology   
      
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   Story Source: Materials provided by Cedars-Sinai_Medical_Center. Note:   
   Content may be edited for style and length.   
      
      
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   Journal Reference:   
      1. Joseph E. Ebinger, Ty J. Gluckman, Jose Magraner, Shih Ting Chiu,   
      Deanna   
         Rider, Chelsey Thomas, Sandeep R. Das, P. Michael Ho, Satya   
         Shreenivas, Steven Bradley. Characterization of Individuals With   
         Apparent Resistant Hypertension Using Contemporary Guidelines:   
         Insights From CV-QUIC.   
      
         Hypertension, 2023; DOI: 10.1161/HYPERTENSIONAHA.123.20894   
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   Link to news story:   
   https://www.sciencedaily.com/releases/2023/06/230626164131.htm   
      
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