(164) The Risk of Cardiovascular Events in Patients with Resistant Hypertension

Publication Number: 499

Background: Resistant Hypertension (RHTN) is a condition that is difficult to treat, defined as uncontrolled blood pressure (BP) in patients adhering to lifestyle modifications and to an appropriate regimen of 3 or more antihypertensive medications from different pharmacological classes, including a diuretic, in the absence of any causes of secondary HTN.

Objectives: To evaluate incidence of ischemic stroke, myocardial infarction (MI), and hospitalization associated with heart failure (HF) in patients with RHTN using real-world data.

Methods: This retrospective cohort study included 7 databases: IBM MarketScan® Commercial (CCAE), IBM MarketScan® Medicare Supplemental (MDCR), IBM MarketScan® Multi-State Medicaid (MDCD), Optum® de-identified Electronic Health Record data set (Optum® EHR), Optum’s de-identified Clinformatics® Data Mart Database (Optum® CDM), IQVIA Adjudicated Health Plan Claims (PharMetrics Plus), and Japan Data Management Consortium claims (JMDC). For this exercise, we defined RHTN as receiving ≥4 antihypertensive medications at the same time (one being diuretic), with 1st dispensing date of the 4th drug as the index date. The clinical assumption was that BP was not at target at the time when the 4th drug was added. Patients were excluded if pregnant or were observed for < 180 days prior to the index date. The outcomes analyzed were incident ischemic stroke, MI, and hospitalization associated with HF, which were ascertained based on emergency room visits or hospitalization records with a 30-day washout period prior to the index date. Patient characteristics were evaluated and incidence rate per 100 person-years (PY) was calculated within each database.

Results: During the study period from 2016 to 2022, the largest cohort of adult patients with RHTN was observed in Optum® EHR (n=616,498), followed by Optum® CDM (n=363,995), PharMetrics Plus (n=270,674). The mean age (SD, years) varied across databases, from 54.0 (7.8) in CCAE, 55.1 (9.7) in JMDC to 70.9 (10.9) in Optum® CDM and 77.1 (8.0) in MDCR. Several comorbid conditions were commonly reported during the baseline period, including hyperlipidemia (28.0% to 56.3%), heart disease (25.5% to 54.5%), diabetes (23.5% to 44.7%), heart failure (7.2% to 36.7%), and renal impairment (11.0% to 22.7%).
The incidence rate ranged from 1.3 [CCAE] to 5.0 [MDCD] per 100 PYs for ischemic stroke and 0.7 [JDMC] to 4.6 [MDCD] per 100 PYs for MI. The incidence rate of hospitalization associated with heart failure was notably higher, ranging from 7.2 [CCAE] to 41.7 [MDCD] per 100 PYs.

Conclusions: Patients with RHTN are commonly seen in clinical practice and associated with a notable risk of cardiovascular events. Optimal treatment strategies are needed to reduce such risks.