Prevalence and Factors Associated With Resistant Hypertension in a Large Health Maintenance Organization in Israel Dahlia Weitzman, Gabriel Chodick, Varda Shalev, Chagai Grossman and Ehud Grossman Hypertension. published online June 23, 2014; Hypertension is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Copyright © 2014 American Heart Association, Inc. All rights reserved. Print ISSN: 0194-911X. Online ISSN: 1524-4563
The online version of this article, along with updated information and services, is located on the World Wide Web at: http://hyper.ahajournals.org/content/early/2014/06/23/HYPERTENSIONAHA.114.03718
Data Supplement (unedited) at: http://hyper.ahajournals.org/content/suppl/2014/06/23/HYPERTENSIONAHA.114.03718.DC1.html
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Original Article Prevalence and Factors Associated With Resistant Hypertension in a Large Health Maintenance Organization in Israel Dahlia Weitzman, Gabriel Chodick, Varda Shalev, Chagai Grossman, Ehud Grossman Abstract—Previous assessments of the prevalence of resistant hypertension (RH) in uncontrolled blood pressure (BP) have ranged from 3% to 30%. Using real-world data, our aim was to estimate the prevalence of RH in patients belonging to the Maccabi Healthcare Services, a 2-million-member health organization in Israel. From 2010 to 2011, all hypertensive patients with ≥2 recorded BP measurements during a minimum period of 6 months were identified. Patients were considered uncontrolled if their most recent BP during the study period and their mean systolic BP or diastolic BP during a preceding period of ≥6months were systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg, or systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg in chronic kidney disease or diabetes mellitus. Uncontrolled patients taking diuretics and ≥2 antihypertensive therapy classes at their maximal recommended dose were regarded as resistant hypertensives. A total of 172 432 patients were eligible for the study. Uncontrolled BP was found in 35.9% (n=65 710). Overall, 2.2% of the uncontrolled patients (n=1487) were resistant hypertensives. Patients with RH were characterized by a significantly (P18 years who had entered the MHS’s hypertension registry before January 1, 2010. Inclusion was based on ≥2 physician’s diagnoses or hospital records and ≥2 BP measurements of systolic BP (SBP) ≥140 or diastolic BP (DBP) ≥ 90 mm Hg. For cases with abnormal measurements but no diagnoses, 4 documented measurements were required where ≥50% of the measurements were SBP >160 mm Hg or DBP >90 mm Hg. Also included were patients with ≥6 dispensed medications for hypertension. Patients were eligible for the study if they had had ≥2 BP measurements during a period of ≥6 months between January 1, 2010, and December 31, 2011. The mean (SD) number of BP measurements per patient was 3.9 (5.1). Patients who left MHS
Received April 10, 2014; first decision April 23, 2014; revision accepted May 25, 2014. From the Primary Care Division, Maccabi Healthcare Services, Tel Aviv, Israel (D.W., G.C., V.S.); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (G.C., V.S., C.G., E.G.); and Rheumatology Unit (C.G.) and Internal Medicine D and Hypertension Unit (E.H.), The Chaim Sheba Medical Center, Tel Hashomer, Israel. The online-only Data Supplement is available with this article at http://hyper.ahajournals.org/lookup/suppl/doi:10.1161/HYPERTENSIONAHA. 114.03718/-/DC1. Correspondence to Ehud Grossman, Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel Hashomer 52621, Israel. E-mail [email protected] © 2014 American Heart Association, Inc. Hypertension is available at http://hyper.ahajournals.org
DOI: 10.1161/HYPERTENSIONAHA.114.03718
Downloaded from http://hyper.ahajournals.org/ at Queen Mary, University of London on June 27, 2014 1
2 Hypertension September 2014 or died before the end of the 6-month follow-up were excluded from the study.
Definition of Outcome An index BP measurement was defined as the last measurement available during the study period (2010–2011). Patients were defined as having uncontrolled hypertension if both the index measurement and the mean of all measurements performed during a period of ≥6 months before the index BP measurement were above the goal. The goal was defined as SBP
The online version of this article, along with updated information and services, is located on the World Wide Web at: http://hyper.ahajournals.org/content/early/2014/06/23/HYPERTENSIONAHA.114.03718
Data Supplement (unedited) at: http://hyper.ahajournals.org/content/suppl/2014/06/23/HYPERTENSIONAHA.114.03718.DC1.html
Permissions: Requests for permissions to reproduce figures, tables, or portions of articles originally published in Hypertension can be obtained via RightsLink, a service of the Copyright Clearance Center, not the Editorial Office. Once the online version of the published article for which permission is being requested is located, click Request Permissions in the middle column of the Web page under Services. Further information about this process is available in the Permissions and Rights Question and Answer document. Reprints: Information about reprints can be found online at: http://www.lww.com/reprints Subscriptions: Information about subscribing to Hypertension is online at: http://hyper.ahajournals.org//subscriptions/
Downloaded from http://hyper.ahajournals.org/ at Queen Mary, University of London on June 27, 2014
Original Article Prevalence and Factors Associated With Resistant Hypertension in a Large Health Maintenance Organization in Israel Dahlia Weitzman, Gabriel Chodick, Varda Shalev, Chagai Grossman, Ehud Grossman Abstract—Previous assessments of the prevalence of resistant hypertension (RH) in uncontrolled blood pressure (BP) have ranged from 3% to 30%. Using real-world data, our aim was to estimate the prevalence of RH in patients belonging to the Maccabi Healthcare Services, a 2-million-member health organization in Israel. From 2010 to 2011, all hypertensive patients with ≥2 recorded BP measurements during a minimum period of 6 months were identified. Patients were considered uncontrolled if their most recent BP during the study period and their mean systolic BP or diastolic BP during a preceding period of ≥6months were systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg, or systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg in chronic kidney disease or diabetes mellitus. Uncontrolled patients taking diuretics and ≥2 antihypertensive therapy classes at their maximal recommended dose were regarded as resistant hypertensives. A total of 172 432 patients were eligible for the study. Uncontrolled BP was found in 35.9% (n=65 710). Overall, 2.2% of the uncontrolled patients (n=1487) were resistant hypertensives. Patients with RH were characterized by a significantly (P18 years who had entered the MHS’s hypertension registry before January 1, 2010. Inclusion was based on ≥2 physician’s diagnoses or hospital records and ≥2 BP measurements of systolic BP (SBP) ≥140 or diastolic BP (DBP) ≥ 90 mm Hg. For cases with abnormal measurements but no diagnoses, 4 documented measurements were required where ≥50% of the measurements were SBP >160 mm Hg or DBP >90 mm Hg. Also included were patients with ≥6 dispensed medications for hypertension. Patients were eligible for the study if they had had ≥2 BP measurements during a period of ≥6 months between January 1, 2010, and December 31, 2011. The mean (SD) number of BP measurements per patient was 3.9 (5.1). Patients who left MHS
Received April 10, 2014; first decision April 23, 2014; revision accepted May 25, 2014. From the Primary Care Division, Maccabi Healthcare Services, Tel Aviv, Israel (D.W., G.C., V.S.); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (G.C., V.S., C.G., E.G.); and Rheumatology Unit (C.G.) and Internal Medicine D and Hypertension Unit (E.H.), The Chaim Sheba Medical Center, Tel Hashomer, Israel. The online-only Data Supplement is available with this article at http://hyper.ahajournals.org/lookup/suppl/doi:10.1161/HYPERTENSIONAHA. 114.03718/-/DC1. Correspondence to Ehud Grossman, Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel Hashomer 52621, Israel. E-mail [email protected] © 2014 American Heart Association, Inc. Hypertension is available at http://hyper.ahajournals.org
DOI: 10.1161/HYPERTENSIONAHA.114.03718
Downloaded from http://hyper.ahajournals.org/ at Queen Mary, University of London on June 27, 2014 1
2 Hypertension September 2014 or died before the end of the 6-month follow-up were excluded from the study.
Definition of Outcome An index BP measurement was defined as the last measurement available during the study period (2010–2011). Patients were defined as having uncontrolled hypertension if both the index measurement and the mean of all measurements performed during a period of ≥6 months before the index BP measurement were above the goal. The goal was defined as SBP
