Treatment-resistant hypertension was associated with lower use of ≥4 antihypertensive classes (14.9% vs 25.0%) and mineralocorticoid receptor antagonists (7.1% vs 26.1%) than controlled hypertension.
Cohort (n=24,999)
What are the antihypertensive treatment patterns and associated blood pressure changes among patients with treatment resistant hypertension compared to controlled hypertension in routine care?
In routine care, patients with controlled hypertension receive broader, comorbidity-driven therapies compared to those with resistant hypertension who more often receive guideline-recommended first-line combinations, though blood pressure declines with each added therapy in both groups.
Objective: To describe antihypertensive treatment patterns and associated blood pressure changes among patients with treatment resistant hypertension (rHTN) and controlled hypertension (cHTN) in routine care.Design and method: We conducted a retrospective cohort study (1-Jan-2017 to 31-Mar-2023) using linked primary care and hospital records. Adults with diagnosed hypertension who received three or more antihypertensive drug classes, including a diuretic, were eligible. Patients were classified as rHTN if blood pressure (BP) was at least 140/90 mmHg and cHTN if <140/90 mmHg at index. Descriptive analyses summarised antihypertensive drug class use at each treatment step, treatment combinations at index, and changes in BP among patients with measurements available from 7–120 days after treatment initiation, compared with measurements within 120 days prior. Results: The study included 18,106 patients (72%) with rHTN and 6,893 with cHTN. Patients with cHTN were older (mean age 68.8 vs 63.7 years), with higher burden of cardiometabolic comorbidities, including heart failure (47.2% vs 16.0%) (Table 1). At index, cHTN patients were prescribed a greater mean number of antihypertensive drug classes than rHTN (3.3 vs 3.2) and were more likely to receive four or more drug classes (25.0% vs 14.9%) (Table 1). The most common combination in rHTN was angiotensin-converting enzyme inhibitor (ACEi), calcium channel blocker, and thiazide-like diuretic (28%), compared with ACEi, beta-blocker, and loop diuretic in cHTN (23.5%) (Figure 1). Prescribing patterns differed between groups, with greater use of first-line antihypertensive classes in rHTN and broader, comorbidity-driven therapies in cHTN (Figure 2); mineralocorticoid receptor antagonists (MRA) were more commonly prescribed in the cHTN (26.1%) than the rHTN (7.1%) group. Among patients with BP recorded both before and after treatment initiation, BP declined following each additional therapy in both groups (Figure 3). Conclusions: A substantial proportion of treated patients had rHTN, suggesting a large unmet need. Treatment patterns differed markedly: rHTN patients more often received guideline-recommended first-line combinations, while cHTN regimens were broader. Blood pressure declined with each added therapy in both groups, yet many rHTN patients remained above target, highlighting variability in treatments and responses in routine care.
Swift et al. (Fri,) conducted a cohort in Hypertension (n=24,999). Treatment resistant hypertension vs. Controlled hypertension was evaluated on Antihypertensive treatment patterns and associated blood pressure changes. Treatment-resistant hypertension was associated with lower use of ≥4 antihypertensive classes (14.9% vs 25.0%) and mineralocorticoid receptor antagonists (7.1% vs 26.1%) than controlled hypertension.