ACC 2015: Intensity and patterns of care in aTRH

March 14, 2015 – Many older patients with uncontrolled aTRH have no hypertension-related clinic visits, according to a new study by DCRI researchers.

sreekanth-vemulapalliApparent treatment-resistant hypertension (aTRH) is a growing problem in the United States and has been associated with worse cardiovascular outcomes in comparison with other forms of hypertension.

Previous studies of aTRH have been confined to closed health care systems or international populations, and may not be representative of the care received by the majority of patients with aTRH in the United States. Moreover, previous studies have not attempted to characterize the frequency of hypertension-related visits and the combination of primary care physicians and specialists treating patients with aTRH.

Recently, the DCRI’s Sreekanth Vemulapalli, MD, and several colleagues sought to address these concerns by looking at data from the nationwide Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, which included 4,894 hypertensive patients aged 65 and older. The results were presented Saturday at the annual Scientific Sessions of the American College of Cardiology in San Diego.

“Our study is the first to attempt to assess the prevalence of guideline-recommended testing for evidence of end organ damage and causes of secondary hypertension among patients with resistant hypertension,” Vemulapalli said. “Together, these analyses help to characterize the current system of care for patients with resistant hypertension in the United States and make it possible to improve upon this system.”

A significant risk factor for cardiovascular disease, aTRH is typically treated by practitioners from various specialties, including primary care physicians, cardiologists, nephrologists, and endocrinologists. According to Vemulapalli, this is the first study in the United States that specifically tries to assess the current system of care for resistant hypertension.

“Improved blood pressure control among patients with resistant hypertension will require not only effective therapies, but also effective and efficient delivery of these therapies to patients,” he said.

Vemulapalli and his colleagues were surprised by a few of their findings. First, they found that 18 percent of the study patients over the age of 65 with uncontrolled aTRH had no hypertension-related clinic visits in a year.

Additionally, data indicated that cardiologists and nephrologists were likely to see patients with aTRH in clinic more frequently for hypertension-related visits than those with non-resistant hypertension. However, primary care physicians saw patients with aTRH in clinic with the same frequency as patients with non-resistant hypertension. Finally, Caucasians and males with uncontrolled aTRH were least likely to be seen more than twice per year for hypertension-related reasons in clinic.

Twenty-five percent of patients with uncontrolled aTRH are seen in clinic for hypertension-related reasons once per year or less often.

“Given that these patients have uncontrolled blood pressure and are known to be at increased risk for cardiovascular events, we will need to identify methods to engage these patients in blood pressure control initiatives,” Vemulapalli said. “Furthermore, since patients with resistant hypertension are seen by cardiologists and nephrologists with increased frequency as compared to those with non-resistant hypertension, efforts to improve blood pressure control among these patients may need to focus in part on cardiology and nephrology practices.

“The next step in understanding the current system of health care delivery to patients with resistant hypertension in the United States will be to describe health care resource utilization in patients with resistant hypertension as compared to those with non-resistant hypertension.”