Chronic Disease

Nine percent of adults with hypertension have resistant hypertension

Nearly 9 percent of adults with hypertension in the United States had resistant hypertension between 2003 and 2008, reveals a new study. Resistant hypertension is when blood pressure remains above goal in spite of the concomitant use of antihypertensive medications from three or more drug classes. Stephen D. Persell, M.D., of Northwestern University, found that adults with resistant hypertension differed in many ways from other adults with similar blood pressure, who were treated with one or two medications. Those with resistant hypertension were more likely to be older, black, and have higher body mass index, impaired kidney function, and a self-reported medical history of coronary heart disease, heart failure, stroke, or diabetes.

Use of diuretics, beta blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers were all common among those with resistant hypertension. Most (85.6 percent) patients with resistant hypertension used a diuretic. However, of the diuretic users, 64.4 percent used the weak diuretic, hydrochlorothiazide. Also, most drug-treated adults with uncontrolled hypertension were receiving medications from only one or two pharmaceutical classes.

The author concludes that use of an inadequate medical regimen appears to be observed far more often than true resistance to a regimen that includes drugs from 3 different pharmaceutical classes. He calls for more clinical research to determine optimal therapeutic strategies for individuals with resistant hypertension. In this study, participants were classified as having resistant hypertension if their blood pressure was greater than 140/90 mm Hg (either systolic or diastolic) and they reported using antihypertensive medications from three different drug classes in the past month or received drugs from four or more antihypertensive drug classes regardless of blood pressure.

Data for the study was drawn from the National Health and Nutrition Examination Survey. This study was supported by the Agency for Healthcare Research and Quality (HS15647).

See "Prevalence of resistant hypertension in the United States, 2003-2008," by Dr. Persell, in the June 2011 Hypertension 57, pp. 1076-1080.

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