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Health-related quality of life in persons with apparent treatment-resistant hypertension on at least four antihypertensives

Journal of Human Hypertension volume 30, pages 191–196 (2016)Cite this article

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Abstract

Little is known about the impact of treatment-resistant hypertension (TRH) on health-related quality of life (HrQoL). We aimed to compare HrQoL measures in adults with apparent TRH (aTRH) and non-resistant hypertension among nationally representative US Medical Expenditure Panel Survey data pooled from 2000 to 2011. Cohorts compared were adults with aTRH (⩾2 unique fills from ⩾4 antihypertensive classes during a year) versus non-resistant hypertension (those with hypertension not meeting the aTRH definition). Key outcomes were cohort differences in SF-12v2 physical component summary (PCS) and mental component summary (MCS) scores and disease-state utility using the SF-6D. Of 57 150 adults with hypertension, 2501 (4.4%) met criteria for aTRH. Persons with aTRH, compared with non-resistant hypertension, were older (mean, 68 vs 61 years), had a higher BMI (30.9 vs 29.7 kg m−2) and were more likely to be Black (20% vs 14%), but less likely to be female (46% vs 54%). Persons with aTRH, compared with non-resistant hypertension, had lower mean PCS scores (35.8 vs 43.2; P<0.0001), and utility (0.68 vs 0.74; P<0.0001), but similar MCS scores (49.1 vs 50.4). In multivariable-adjusted analyses, aTRH was associated with a 2.37 (95% CI 1.71 to 3.02) lower PCS score and 0.02 (95% CI 0.01 to 0.03) lower utility, compared with non-resistant hypertension. In conclusion, aTRH was associated with substantially lower HrQoL in physical functioning and health utility, but not in mental functioning, compared with non-resistant hypertension. The multivariable-adjusted reduction in physical functioning was similar in magnitude to previous observations comparing hypertension with no hypertension.

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References

  1. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J . Global burden of hypertension: analysis of worldwide data. Lancet 2005; 365 (9455): 217–223.

    Article  Google Scholar 

  2. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380 (9859): 2224–2260.

    Article  Google Scholar 

  3. Egan BM, Zhao Y, Axon RN, Brzezinski WA . Ferdinand KC. Uncontrolled and apparent treatment resistant hypertension in the United States, 1988 to 2008. Circulation 2011; 124 (9): 1046–1058.

    Article  Google Scholar 

  4. Pierdomenico SD, Lapenna D, Bucci A, Di Tommaso R, Di Mascio R, Manente BM et al. Cardiovascular outcome in treated hypertensive patients with responder, masked, false resistant, and true resistant hypertension. Am J Hypertens 2005; 18 (11): 1422–1428.

    Article  Google Scholar 

  5. Kumbhani DJ, Steg PG, Cannon CP, Eagle KA, Smith SC Jr, Crowley K et al. Resistant hypertension: a frequent and ominous finding among hypertensive patients with atherothrombosis. Eur Heart J 2013; 34 (16): 1204–1214.

    Article  CAS  Google Scholar 

  6. De Nicola L, Gabbai FB, Agarwal R, Chiodini P, Borrelli S, Bellizzi V et al. Prevalence and prognostic role of resistant hypertension in chronic kidney disease patients. J Am Coll Cardiol 2013; 61 (24): 2461–2467.

    Article  Google Scholar 

  7. Smith SM, Gong Y, Handberg E, Messerli FH, Bakris GL, Ahmed A et al. Predictors and outcomes of resistant hypertension among patients with coronary artery disease and hypertension. J Hypertens 2014; 32 (3): 635–643.

    Article  CAS  Google Scholar 

  8. Smith SM, Huo T, Delia Johnson B, Bittner V, Kelsey SF, Vido Thompson D et al. Cardiovascular and mortality risk of apparent resistant hypertension in women with suspected myocardial ischemia: a report from the NHLBI-sponsored WISE Study. J Am Heart Assoc 2014; 3 (1): e000660.

    Article  Google Scholar 

  9. Daugherty SL, Powers JD, Magid DJ, Tavel HM, Masoudi FA, Margolis KL et al. Incidence and prognosis of resistant hypertension in hypertensive patients. Circulation 2012; 125 (13): 1635–1642.

    Article  Google Scholar 

  10. Bangalore S, Fayyad R, Laskey R, Demicco DA, Deedwania P, Kostis JB et al. Prevalence, predictors, and outcomes in treatment-resistant hypertension in patients with coronary disease. Am J Med 2014; 127 (1): 71–81.

    Article  Google Scholar 

  11. Irvin MR, Booth JN 3rd, Shimbo D, Lackland DT, Oparil S, Howard G et al. Apparent treatment-resistant hypertension and risk for stroke, coronary heart disease and all-cause mortality. J Am Soc Hypertens 2014; 8 (6): 405–413.

    Article  Google Scholar 

  12. Trevisol DJ, Moreira LB, Kerkhoff A, Fuchs SC, Fuchs FD . Health-related quality of life and hypertension: a systematic review and meta-analysis of observational studies. J Hypertens 2011; 29: 179–188.

    Article  CAS  Google Scholar 

  13. Vemulapalli S, Ard J, Bakris GL, Bhatt DL, Brown AS, Cushman WC et al. Proceedings from duke resistant hypertension think tank. Am Heart J 2014; 167 (6): 775–788.

    Article  Google Scholar 

  14. Rumsfeld JS, Alexander KP, Goff DC Jr, Graham MM, Ho PM, Masoudi FA et al. Cardiovascular health: the importance of measuring patient-reported health status: a scientific statement from the American Heart Association. Circulation 2013; 127 (22): 2233–2249.

    Article  Google Scholar 

  15. Ware JE, Kosinski M, Keller SD . A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Med Care 1996; 34: 220–233.

    Article  Google Scholar 

  16. Brazier JE, Roberts J . The estimation of a preference-based measure of health from the SF-12. Med Care 2004; 42: 851–859.

    Article  Google Scholar 

  17. Norman GR, Sloan JA, Wyrwich KW . Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care 2003; 41 (5): 582–592.

    PubMed  Google Scholar 

  18. Poljicanin T, Ajdukovic D, Sekerija M, Pibernik-Okanovic M, Metelko Z, Vuletic Mavrinac G . Diabetes mellitus and hypertension have comparable adverse effects on health-related quality of life. BMC Public Health 2010; 10: 12.

    Article  Google Scholar 

  19. Stewart AL, Greenfield S, Hays RD, Wells K, Rogers WH, Berry SD et al. Functional status and well-being of patients with chronic conditions. Results from the Medical Outcomes Study. JAMA 1989; 262 (7): 907–913.

    Article  CAS  Google Scholar 

  20. Calhoun DA, Jones D, Textor S, Goff DC, Murphy TP, Toto RD et al. Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation 2008; 117 (25): e510–e526.

    Article  Google Scholar 

  21. Trevisol DJ, Moreira LB, Fuchs FD, Fuchs SC . Health-related quality of life is worse in individuals with hypertension under drug treatment: results of population-based study. J Hum Hypertens 2012; 26: 374–380.

    Article  CAS  Google Scholar 

  22. Korhonen PE, Kivelä SL, Kautiainen H, Jarvenpaa S, Kantola I . Health-related quality of life and awareness of hypertension. J Hypertens 2011; 29: 2070–2074.

    Article  CAS  Google Scholar 

  23. Li W, Liu L, Puente JG, Li Y, Jiang X, Jin S et al. Hypertension and health-related quality of life: An epidemiological study in patients attending hospital clinics in China. J Hypertens 2005; 23: 1667–1676.

    Article  CAS  Google Scholar 

  24. Mena-Martin FJ, Martin-Escudero JC, Simal-Blanco F, Carretero-Ares JL, Arzua-Mouronte D, Herreros-Fernandez V . Health-related quality of life of subjects with known and unknown hypertension: results from the population-based Hortega study. J Hypertens 2003; 21: 1283–1289.

    Article  CAS  Google Scholar 

  25. Banegas JR, Guallar-Castillon P, Rodriguez-Artalejo F, Graciani A, Lopez-Garcia E, Ruilope LM . Association between awareness, treatment, and control of hypertension and quality of life among older adults in Spain. Am J Hypertens 2006; 19: 686–693.

    Article  Google Scholar 

  26. Lambert GW, Hering D, Esler MD, Marusic P, Lambert EA, Tanamas SK et al. Health-related quality of life after renal denervation in patients with treatment-resistant hypertension. Hypertension 2012; 60 (6): 1479–1484.

    Article  CAS  Google Scholar 

  27. Gong Y, Handberg EM, Gerhard T, Cooper-DeHoff RM, Ried LD, Johnson JA et al. Systolic blood pressure and subjective well-being in patients with coronary artery disease. Clin Cardiol 2009; 32 (11): 627–632.

    Article  Google Scholar 

  28. Bhatt DL, Kandzari DE, O'Neill WW, D’Agostino R, Flack JM, Katzen BT et al. A controlled trial of renal denervation for resistant hypertension. N Engl J Med 2014; 370: 1393–1401.

    Article  CAS  Google Scholar 

  29. Hays RD, Reeve BB, Smith AW, Clauser SB . Associations of cancer and other chronic medical conditions with SF-6D preference-based scores in Medicare beneficiaries. Qual Life Res 2014; 23: 385–391.

    Article  Google Scholar 

  30. Walters SJ, Brazier JE . What is the relationship between the minimally important difference and health state utility values? The case of the SF-6D. Health Qual Life Outcomes 2003; 1: 4.

    Article  Google Scholar 

  31. Hanmer J, Lawrence WF, Anderson JP, Kaplan RM, Fryback DG . Report of nationally representative values for the noninstitutionalized US adult population for 7 health-related quality-of-life scores. Med Decis Making 2006; 26 (4): 391–400.

    Article  Google Scholar 

  32. Sullivan PW, Ghushchyan V . Preference-based EQ-5D index scores for chronic conditions in the United States. Med Dec Making 2006; 26: 410–420.

    Article  Google Scholar 

  33. Smith SM . Epidemiology, prognosis, and treatment of resistant hypertension. Pharmacotherapy 2013; 33 (10): 1071–1086.

    Article  Google Scholar 

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Authors and Affiliations

  1. Departments of Pharmacotherapy & Translational Research and Community Health & Family Medicine, Colleges of Pharmacy and Medicine, University of Florida, Gainesville, FL, USA

    N W Carris & S M Smith

  2. Department of Economics, American University of Armenia, Yerevan, Armenia

    V Ghushchyan

  3. Department of Clinical Pharmacy and Center for Pharmaceutical Outcomes Research, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA

    V Ghushchyan & A M Libby

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  1. N W Carris
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Correspondence to S M Smith.

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Carris, N., Ghushchyan, V., Libby, A. et al. Health-related quality of life in persons with apparent treatment-resistant hypertension on at least four antihypertensives. J Hum Hypertens 30, 191–196 (2016). https://doi.org/10.1038/jhh.2015.61

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