Abstract 17036: Uncontrolled Apparent Treatment Resistant Hypertension is Associated With Increased Hospitalization and Increased Total Hospital Reimbursements
Background: Apparent treatment resistant hypertension (aTRH) is defined as uncontrolled BP with three or more antihypertensives or controlled BP with 4 or more antihypertensives. ATRH is associated with increased adverse cardiovascular outcomes, however, little is known about healthcare utilization and expenses in those with aTRH.
Methods: The study included participants 65 years and older in the nationwide Reasons for Geographic and Racial Differences in Stroke (REGARDS) study with fee for service Medicare insurance. ATRH was defined as treatment with three or more antihypertensives of different classes. Participants were categorized as hypertensive without aTRH (no aTRH), controlled aTRH (BP ≤140/90), and uncontrolled aTRH (BP ≥ 140/90). Healthcare expenses were determined using diagnoses in Medicare parts A and B claims.
Results: At baseline, 3933 (84.5%) had no aTRH, 247 (5.3%) had controlled aTRH, and 474 (10.2%) had uncontrolled aTRH. Compared to participants with no aTRH, those with uncontrolled aTRH and controlled aTRH were more likely to be male (45.7%, 50.4%, 53.8%) and black (48.5%, 47.0%, 35.6%), respectively. Participants with uncontrolled and controlled aTRH also had a higher prevalence of atrial fibrillation, stroke, and coronary artery disease compared to those with no aTRH. Adjusted annual median outpatient total reimbursements per patient were similar between those with uncontrolled aTRH, controlled aTRH, and no aTRH ($5248 [IQR $2904, $10006], $5697 [IQR $3104, $9930], $4525 [IQR $2587, $7923]). Uncontrolled aTRH, but not controlled aTRH was associated with an increased adjusted annual rate of hospitalizations as compared to no aTRH (risk ratio=1.13; 95% CI [IQR 1.03 - 1.24]; p=0.01). Among patients with any hospitalizations, uncontrolled aTRH was associated with the highest median annual inpatient total reimbursements ($6324 [IQR 3149, 16238]; controlled aTRH = $5507 [IQR 2197, 13884]; no aTRH $4968 [IQR 2252, 10882]).
Conclusions: Uncontrolled aTRH is associated with an increased rate of hospitalizations and higher charges per hospitalization. Efforts to improve blood pressure control among patients with uncontrolled aTRH may also result in reduced hospitalizations and hospital charges.
Author Disclosures: S. Vemulapalli: Other; Modest; Abbott Vascular. Research Grant; Significant; American College of Cardiology, Boston Scientific. Consultant/Advisory Board; Significant; Premiere Research, Inc. L. Deng: None. M. Patel: Research Grant; Significant; Astra Zeneca, Johnson and Johnson, National Heart Lung and Blood Institute, Genzyme. Consultant/Advisory Board; Significant; Bayer Healthcare, Ortho McNeil Jansen, Medscape - the heart.org. M.L. Kilgore: None. L.H. Curtis: None. R. Irvin: None. L.P. Svetkey: None. D. Shimbo: None. D.A. Calhoun: None. P. Muntner: Research Grant; Significant; Amgen Inc..
- © 2015 by American Heart Association, Inc.