Abstract 13365: Real World Clinical Outcomes Associated With Controlled versus Uncontrolled Blood Pressure in Patients With Apparent Treatment Resistant Hypertension

AHA estimated 10.3 million US adults with apparent treatment resistant hypertension (aTRH) in 2018; limited data exist regarding clinical outcomes for these patients. This retrospective cohort study assessed risk of major adverse cardiac events (MACE: stroke, myocardial infarction, heart failure hospitalization) and end stage renal disease (ESRD) among aTRH patients, comparing those with controlled blood pressure (CBP; SBP/DBP <130/80 mm Hg) vs uncontrolled blood pressure (UBP; ≥130/80 mm Hg), using linked IQVIA Ambulatory EMR- US and IQVIA PharMetrics® Plus claims data. Patients taking ≥3 antihypertensive (anti-HTN) classes within 30 days (index regimen) between 1/1/2015 and 6/30/2021, having ≥2 BP values post-index regimen (2 nd BP date = index date) with ≥12 months pre-index enrollment (baseline) were included. Unbalanced covariates were adjusted in the multivariable model. Cohorts consisted of 11,427 CBP and 22,333 UBP patients: mean (SD) age 62 (13) vs 60 (12) years, female (48% vs 46%), African-American (8% vs 12%), mean (SD) baseline SBP/DBP 118 (8)/70 (6) vs 141 (14)/82 (9) mm Hg, mean (SD) BMI 32 (8) vs 34 (10) kg/m 2 , respectively. The index regimen consisted of 3, 4, or ≥5 anti-HTN classes in 82% vs 79%, 15% vs 18%, and 2% vs 3% of CBP vs UBP patients, respectively (all p<0.001). Frequently observed baseline comorbidities in CBP vs UBP patients included hyperlipidemia (79% vs 76%), mild to moderate diabetes (43% vs 42%), chronic pulmonary disease (31% vs 25%), and congestive heart failure (27% vs 16%). Mean (SD) follow-up time was 2.7 (2.1) years for both cohorts. Patients with UBP were at 8% and 53% increased risk of developing MACE and ESRD, respectively, MACE risk was mainly driven by a 31% increased risk of stroke (figure). Despite being treated with 3+ anti-HTN classes, 66% of aTRH patients had UBP and demonstrated increased risk of MACE and ESRD compared to CBP patients. Development of future innovative treatment approaches can add value in the management of aTRH.