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CME: Treatment-Resistant Hypertension: Assessing Predictors & Outcomes

CME: Treatment-Resistant Hypertension: Assessing Predictors & Outcomes

“The topic of treatment-resistant HTN has gained attention in recent years,” says Rhonda M. Cooper-DeHoff, PharmD, MS, FAHA, FACC. “The condition increases long-term risk for poor outcomes, regardless of whether or not HTN is controlled or uncontrolled. Unfortunately, we’re lacking important data on the long-term effects of treatment-resistant HTN.” Coronary artery disease (CAD) is among the leading causes of mortality, and treatment-resistant HTN is more common in patients with CAD than without CAD. Little is known, however, about the impact that treatment-resistant HTN has on cardiovascular outcomes in patients with CAD. Such data may inform clinicians on strategies to aggressively manage risk factors. Identifying Predictors & Impact In the Journal of Hypertension, Dr. Cooper-DeHoff and colleagues published a study that described the prevalence, predictors, and impact on adverse cardiovascular outcomes of resistant HTN among patients with CAD and HTN. More than 17,000 study participants were divided into three groups according to achieved BP: 1) controlled (BP<140/90 mm Hg on three or fewer drugs); 2) uncontrolled (BP≥140/90 mm Hg on two or fewer drugs); or 3) resistant (BP≥140/90 mm Hg on three drugs or any patient on at least four drugs). “We found that resistant HTN occurred in 38% of patients with CAD and HTN,” says Dr. Cooper-DeHoff. “Those with resistant HTN were at increased risk for having poorer outcomes.” Several characteristics were associated with an increased risk of resistant HTN, including a history of heart failure, diabetes, and renal insufficiency, among others (Figure 1). Overall, 13 independent predictors of resistant HTN were identified. Many of these characteristics can be obtained noninvasively and help clinicians recognize these patients in the clinic. “The prevalence...
Treatment-Resistant Hypertension: Assessing Predictors & Outcomes

Treatment-Resistant Hypertension: Assessing Predictors & Outcomes

Treatment-resistant hypertension (HTN) has been defined in various ways in clinical research. Some definitions go so far as to say which medications should be used before classifying patients as having resistant HTN. Regardless of the definition, the overriding theme of treatment-resistant HTN is that it occurs when several anti-hypertensive drugs are needed to control blood pressure (BP). Studies suggest that treatment-resistant HTN is present in 20% to 30% of patients with HTN. Its prevalence has more than doubled over the past 25 years, and research has linked it to an increased risk of cardiovascular events when compared with patients without treatment-resistant HTN. “The topic of treatment-resistant HTN has gained attention in recent years,” says Rhonda M. Cooper-DeHoff, PharmD, MS, FAHA, FACC. “The condition increases long-term risk for poor outcomes, regardless of whether or not HTN is controlled or uncontrolled. Unfortunately, we’re lacking important data on the long-term effects of treatment-resistant HTN.” Coronary artery disease (CAD) is among the leading causes of mortality, and treatment-resistant HTN is more common in patients with CAD than without CAD. Little is known, however, about the impact that treatment-resistant HTN has on cardiovascular outcomes in patients with CAD. Such data may inform clinicians on strategies to aggressively manage risk factors. Identifying Predictors & Impact In the Journal of Hypertension, Dr. Cooper-DeHoff and colleagues published a study that described the prevalence, predictors, and impact on adverse cardiovascular outcomes of resistant HTN among patients with CAD and HTN. More than 17,000 study participants were divided into three groups according to achieved BP: 1) controlled (BP<140/90 mm Hg on three or fewer drugs); 2) uncontrolled (BP≥140/90 mm Hg on...
Data Standards for ACS & CAD

Data Standards for ACS & CAD

With the emergence of electronic health records (EHRs) and administrative and professional databases, it’s critical to facilitate clear communication and assure the accurate interchange of data and information. Clinical data standards are important for managing patients, assessing outcomes, and conducting research. Having a broad agreement on a common vocabulary and a standardized list of data elements helps lay the groundwork for future clinical registries and quality- improvement initiatives. It also can be used in the development of performance measures. An Important Update In 2013, the American College of Cardiology (ACC) and American Heart Association (AHA), in conjunction with 11 other organizations, developed a list of key data elements with standardized definitions for patients with acute coronary syndromes (ACS) and coronary artery disease (CAD). The document was published jointly in the Journal of the American College of Cardiology and Circulation. It updates information on elements specific to ACS that were released in 2001. CAD was added because of the overlap between the two conditions. The ACC/AHA publication listed key data elements and provided detailed definitions in seven categories, including demographics and admissions; history and risk factors; clinical presentation; diagnostic procedure; invasive therapeutic intervention; medications; and outcomes. The document is organized in tabular form to be a helpful tool for everyday use. Special attention is also given to important predictors of outcomes, including laboratory results and clinical presentation. This information should be mandatory reading for clinical investigators, quality assurance personnel, and research nurses. For cardiologists, the latest terminology and methods may seem obvious at first glance. However, even the most sophisticated practitioners can discover better ways to communicate and describe ambiguous...

CAD in Patients With Advanced Lung Disease

American researchers suggest that coronary artery disease not only appears to be common among patients with advanced lung disease attributable to COPD or interstitial lung disease, but also appears to be underdiagnosed. The team also found under-utilization of guideline-recommended cardio-protective medications in this population. Abstract: American Journal of Medicine, December...

Statin Non-Adherence & Treatment Intensification

A review of more than 125,000 patients on stable statin therapy suggests that nearly half (44%) of those who had their treatment intensified were non-adherent to their treatment. When compared with adherent patients, those who were not were 30% more likely to have had their statin therapy intensified. Those with statin therapy intensification were more likely to be younger, female, and have coronary artery disease, diabetes, hypertension, dyslipidemia, stroke, peripheral arterial disease, heart failure, or depression. Abstract: American Journal of Cardiology, November 15,...
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