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Apparent Treatment-Resistant Hypertension: Missed Opportunities to Achieve Blood Pressure Control in Black Adults

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Aisha T. Langford, PhD, MPH Assistant Professor  Department of Population Health Co-Director, CTSI Recruitment and Retention Core  NYU Grossman School of Medicine NYU Langone Health New York, NY 10016

Apparent Treatment-Resistant Hypertension: Missed Opportunities to Achieve Blood Pressure Control in Black Adults

MedicalResearch.com Interview with:

Dr. Langford

Aisha T. Langford, PhD, MPH
Assistant Professor
Department of Population Health
Co-Director, CTSI Recruitment and Retention Core
NYU Grossman School of Medicine
NYU Langone Health
New York, NY 10016

MedicalResearch.com: What is the background for this study?

Response: In 2018, the American Heart Association (AHA) published an updated Scientific Statement on Resistant Hypertension. The term apparent treatment-resistant hypertension (aTRH) is used when pseudoresistance (e.g., white coat effect, medication nonadherence) cannot be excluded. The current study was designed to investigate if Black adults with aTRH, a group disproportionately affected by cardiovascular disease, receive evidence-based approaches to lower blood pressure as recommended in the 2018 AHA Scientific Statement.

Specifically, we studied healthy lifestyle factors including not smoking, not consuming alcohol, ≥75 minutes of vigorous-intensity or ≥150 minutes of moderate or vigorous physical activity per week, and body mass index <25 kg/m2; and recommended antihypertensive medication classes among US Black adults.

MedicalResearch.com: What are the main findings?

Response: Among participants with apparent treatment-resistant hypertension, 14.5% and 1.2% had ideal levels of 3 and 4 of the lifestyle factors, respectively. Also, 5.9% of participants with aTRH reported taking a thiazide-like diuretic, and 9.8% reported taking a mineralocorticoid receptor antagonist. 

MedicalResearch.com: What should readers take away from your report?

Response: The present study suggests that lifestyle factors and thiazide-like diuretics and mineralocorticoid receptor antagonists are underutilized among Black adults with apparent treatment-resistant hypertension. This represents a missed opportunity to efficiently achieve blood pressure control in Black adults.  

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: I’m conducting new research on shared decision making between Black adults and their primary care doctors, including decisions about using nutrition and heart-healthy, evidence-based eating plans like the DASH diet to battle hypertension. In addition, more research on how doctors choose to prescribe certain types of blood pressure medication may also be helpful. 

MedicalResearch.com: Is there anything else you would like to add? 

Response: I hope our study will continue to raise awareness about the importance of blood pressure control in black adults with aTRH. Strategies such as shared decision making may help promote lifestyle modifications among black patients with aTRH, particularly as it relates to physical activity and weight management. For clinicians, the use of clinical decision supports may increase the likelihood that recommended antihypertensive medications for aTRH including thiazide-like diuretics and mineralocorticoid receptor antagonists will be prescribed.

Any disclosures?

I have no disclosures to report.

Citation:

Underutilization of Treatment for Black Adults With Apparent Treatment-Resistant Hypertension

Aisha T. Langford, Oluwasegun P. Akinyelure, Tony L. Moore Jr, George Howard, Yuan-I Min, William B. Hillegass, Adam P. Bress, Gabriel S. Tajeu, Mark Butler, Byron C. Jaeger, Yuichiro Yano, Daichi Shimbo, Gbenga Ogedegbe, David Calhoun, John N. Booth III, Paul Muntner
https://doi.org/10.1161/HYPERTENSIONAHA.120.14836Hypertension

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Sep 16, 2020 @ 7:56 pm

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