Abstract 92: Prevalence and Predictors of Apparent Treatment-Resistant Hypertension among Individuals with a History of Physician-Diagnosed Stroke or TIA

Abstract

Background: Uncontrolled blood pressure (BP) and use of multiple antihypertensive medication classes are common among persons with a history of stroke, suggesting prevalence of resistant hypertension may be high in this population. In a cohort of persons with hypertension, we sought to determine prevalence of apparent treatment-resistant hypertension (aTRH) among those with a history of stroke and/or TIA. Additionally, demographics and clinical factors associated with aTRH were determined. Methods: This cross-sectional analysis used data from REGARDS, a national, population-based, longitudinal study of 30,239 black and white adults ≥ 45 years, enrolled 2003-2007. Baseline data collection included centralized telephone interview for medical history, including self-report of physician diagnosed stroke or TIA. Analysis was restricted to 14,160 participants with hypertension, defined as SBP ≥ 140 mmHg, DBP ≥ 90 mmHg, or self-reported use of antihypertensive medications. aTRH was defined as: 1) uncontrolled BP (systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg) with concurrent use of ≥ 3 antihypertensive medication classes, or 2) use of ≥ 4 antihypertensive medication classes, regardless of BP level. We used Poisson regression to calculate predictors of aTRH. Results: Among all hypertensive participants, 2,208 (15.6%) had aTRH, however, 433/1,961 (22.1%) with a history of stroke/TIA had aTRH . After adjustment for age, race and sex, participants with history of stroke/TIA were more likely to have aTRH (prevalence ratio [PR] = 1.43; 95% CI: 1.30 - 1.57) although the association was partially mediated by adjustment for risk factors and socio-economic status (PR = 1.15; 95% CI: 1.04 - 1.28). Among stroke/TIA participants, aTRH was more common in blacks (PR = 1.70; 95% CI: 1.43 - 2.02), larger waists (PR = 1.31 per 15 cm; 95% CI: 1.22 - 1.42), diabetes (PR = 1.62; 95% CI: 1.37 - 1.91), albumin-to-creatinine ratio ≥ 30 mg/g (PR = 1.87; 1.59 - 2.20), and history of myocardial infarction (PR = 1.34; 95% CI: 1.12 - 1.59). Conclusions: In this study, over 20% of persons with stroke/TIA had aTRH. As current guidelines recommend BP reduction in these individuals, our results support identification of those who may need more intensive BP monitoring and management.