In this study, we will use electronic health data records spanning 20 years to establish trends in the prevalence and incidence of resistant hypertension. Resistant hypertension is high blood pressure that does not respond to treatment with at least three blood-pressure lowering drugs. Our results will provide up to date information on the changing burden of this important risk factor for heart disease. This is especially valuable in light of an ageing and ever obese population, both of which increase the risk of high blood pressure. Furthermore, we will assess the prognosis of adults with resistant hypertension in comparison to adults without resistant hypertension. We will assess whether people with resistant hypertension have more bad outcomes such as such heart attacks, strokes, deaths, heart failure and kidney disease than people without resistant hypertension. Our results will also be helpful in that they will provide information on how different types of patient characteristics predict having an outcome like a heart attack or stroke, and this information can then be used in identifying people who are high priority for improving blood pressure management.
Using the CPRD-GOLD database, we will identify all the prevalence and incidence of resistant hypertension between 1995 and 2015. We will measure trends for prevalence and incidence, adjusted for age and gender using poisson regression. In addition, we will conduct a prognosis study, comparing the rate of myocardial infarction, stroke, all cause death, heart failure and renal failure in those with resistant hypertension and those without. We will examine the robustness of our definitions and assumptions through various sensitivity analyses.
Primary outcomes: A composite of an individual's first event of myocardial infarction, stroke, or all-cause mortality.. Secondary outcomes: The individual components of the primary outcome, renal failure (defined as progression to chronic kidney disease stage 3, end stage renal disease, dialysis or transplant) and heart failure.
Sarah-Jo Sinnott - Chief Investigator - Not from an Organisation
Sarah-Jo Sinnott - Corresponding Applicant - Not from an Organisation
Elizabeth Williamson - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Ian Douglas - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Ian Pavord - Collaborator - University of Oxford
Laurie Tomlinson - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Liam Smeeth - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation