Characteristics and Predictors of Apparent Treatment Resistant Hypertension in Real-World Populations Using Electronic Health Record-Based Data

Background: Apparent treatment-resistant hypertension (aTRH) is defined as uncontrolled blood pressure (BP) despite using ≥3 antihypertensive classes or controlled BP while using ≥4 antihypertensive classes. Patients with aTRH have a higher risk for adverse cardiovascular outcomes compared to patients with controlled hypertension. Although there have been prior reports on the prevalence, characteristics, and predictors of aTRH, these have been broadly derived from smaller datasets, randomized controlled trials, or closed healthcare systems. Methods: We extracted patients with hypertension defined by ICD 9 and 10 codes during 1/1/2015-12/31/2018, from two large electronic health record databases: the OneFlorida Data Trust (n=223,384) and Research Action for Health Network (REACHnet) (n=175,229). We applied our previously validated aTRH and stable controlled hypertension (HTN) computable phenotype algorithms and performed univariate and multivariate analyses to identify the prevalence, characteristics, and predictors of aTRH in these real-world populations. Results: The prevalence of aTRH in OneFlorida (16.7%) and REACHnet (11.3%) was similar to prior reports. Both populations had a significantly higher proportion of black patients with aTRH compared to those with stable controlled HTN. aTRH in both populations shared similar significant predictors, including black race, diabetes, heart failure, chronic kidney disease, cardiomegaly, and higher body mass index. In both populations, aTRH was significantly associated with similar comorbidities, when compared with stable controlled HTN. Conclusion: In two large, diverse real-world populations, we observed similar comorbidities and predictors of aTRH as prior studies. In the future, these results may be used to improve healthcare professionals' understanding of aTRH predictors and associated comorbidities. Clinical Perspective: Large, diverse real-world populations showed a similar prevalence of aTRH, 16.7% in OneFlorida and 11.3% in REACHnet, compared to those observed from other cohorts.Patients classified as apparent treatment resistant hypertension were significantly older and had a higher prevalence of comorbid conditions such as diabetes, dyslipidemia, coronary artery disease, heart failure with preserved ejection fraction, and chronic kidney disease stages 1-3.Within diverse, real-world populations, the strongest predictors for apparent treatment resistant hypertension were black race, higher body mass index, heart failure, chronic kidney disease, and diabetes.