Cardiovascular Health and Transition From Controlled Blood Pressure to Apparent Treatment Resistant Hypertension: The Jackson Heart Study and the REGARDS Study

• Published in: Hypertension (Dallas, Tex. 1979) Vol. 76; no. 6; pp. 1953 - 1961
• Main Authors: Akinyelure, Oluwasegun P., Sakhuja, Swati, Colvin, Calvin L., Clark, Donald, Jaeger, Byron C., Hardy, Shakia T., Howard, George, Cohen, Laura P., Irvin, Marguerite R., Tanner, Rikki, Carey, Robert M., Muntner, Paul
• Format: Journal Article
• Language: English
• Published: United States American Heart Association, Inc 01-12-2020
• Subjects: Aged; American Heart Association; Antihypertensive Agents - therapeutic use; Blood Pressure - drug effects; Blood Pressure - physiology; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - physiopathology; Cardiovascular System - drug effects; Cardiovascular System - physiopathology; Drug Resistance; Exercise - physiology; Female; Health Surveys - methods; Health Surveys - statistics & numerical data; Humans; Hypertension - drug therapy; Hypertension - physiopathology; Longitudinal Studies; Male; Middle Aged; Proportional Hazards Models; Risk Factors; United States; United States; blood pressure; glucose; body mass index; resistant hypertension; cardiovascular health; Life’s Simple 7; physical activity
• ISSN: 0194-911X; 1524-4563
• DOI: 10.1161/HYPERTENSIONAHA.120.15890

Almost 1 in 5 US adults with hypertension has apparent treatment resistant hypertension (aTRH). Identifying modifiable risk factors for incident aTRH may guide interventions to reduce the need for additional antihypertensive medication. We evaluated the association between cardiovascular health and incident aTRH among participants with hypertension and controlled blood pressure (BP) at baseline in the Jackson Heart Study (N=800) and the Reasons for Geographic and Racial Differences in Stroke study (N=2316). Body mass index, smoking, physical activity, diet, BP, cholesterol and glucose, categorized as ideal, intermediate, or poor according to the American Heart Association’s Life’s Simple 7 were assessed at baseline and used to define cardiovascular health. Incident aTRH was defined by uncontrolled BP, systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg, while taking ≥3 classes of antihypertensive medication or controlled BP, systolic BP <130 mm Hg and diastolic BP <80 mm Hg, while taking ≥4 classes of antihypertensive medication at a follow-up visit. Over a median 9 years of follow-up, 605 (19.4%) participants developed aTRH. Incident aTRH developed among 25.8%, 18.2%, and 15.7% of participants with 0 to 1, 2, and 3 to 5 ideal Life’s Simple 7 components, respectively. No participants had 6 or 7 ideal Life’s Simple 7 components at baseline. The multivariable adjusted hazard ratios (95% CIs) for incident aTRH associated with 2 and 3 to 5 versus 0 to 1 ideal components were 0.75 (0.61–0.92) and 0.67 (0.54–0.82), respectively. These findings suggest optimizing cardiovascular health may reduce the pill burden and high cardiovascular risk associated with aTRH among individuals with hypertension.