Proceedings from Duke resistant hypertension think tank

Sreekanth Vemulapalli, Jamy Ard, George L. Bakris, Deepak L. Bhatt, Alan S. Brown, William Cushman, Keith C. Ferdinand, John M. Flack, Jerome L. Fleg, Barry T. Katzen, John B. Kostis, Suzanne Oparil, Chet B. Patel, Carl J. Pepine, Ileana L. Piña, Krishna J. Rocha-Singh, Raymond R. Townsend, Eric D. Peterson, Robert M. Califf, Manesh R. Patel

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

To identify patients at increased risk for cardiovascular outcomes, apparent treatment resistant hypertension (aTRH) is defined as having a blood pressure (BP) above goal despite the use of ≥3 antihypertensive therapies of different classes at maximally tolerated doses, ideally including a diuretic. In light of growing scientific interest in the treatment of this group, a multistakeholder think tank was convened to discuss the current state of knowledge, improve the care of these patients, and identify appropriate study populations for future observational and randomized trials in the field. Although recent epidemiologic studies in selected populations estimate that the prevalence of aTRH is 10% to 15% of hypertensive patients, further large-scale observational studies will be needed to better elucidate risk factors. To spur the development of therapies for aTRH, the development of an "aTRH" label for pharmacologic and device therapies with a developmental pathway including treatment added to the use of existing therapies is favored. Although demonstration of adequate BP lowering should be sufficient to gain Food and Drug Administration approval for therapies targeting aTRH, assessment of improvement in quality of life and cardiovascular outcomes is also desirable and considered in Centers for Medicare and Medicaid Services coverage decisions. Device trials under the aTRH label will need uniform and consistent processes for defining appropriate patient populations as well as postapproval registries assessing both long-term safety and duration of responses. Finally, patients with aTRH are likely to benefit from evaluation by a hypertension team to assure proper patient identification, diagnostic work-up, and therapeutic management before consideration of advanced or novel therapies to lower BP.

Original languageEnglish (US)
JournalAmerican Heart Journal
Volume167
Issue number6
DOIs
StatePublished - Jan 1 2014

Fingerprint

Hypertension
Therapeutics
Blood Pressure
Population
Drug Approval
Centers for Medicare and Medicaid Services (U.S.)
Equipment and Supplies
Maximum Tolerated Dose
United States Food and Drug Administration
Diuretics
Antihypertensive Agents
Observational Studies
Registries
Epidemiologic Studies
Patient Care
Quality of Life
Safety

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Vemulapalli, S., Ard, J., Bakris, G. L., Bhatt, D. L., Brown, A. S., Cushman, W., ... Patel, M. R. (2014). Proceedings from Duke resistant hypertension think tank. American Heart Journal, 167(6). https://doi.org/10.1016/j.ahj.2014.02.008

Proceedings from Duke resistant hypertension think tank. / Vemulapalli, Sreekanth; Ard, Jamy; Bakris, George L.; Bhatt, Deepak L.; Brown, Alan S.; Cushman, William; Ferdinand, Keith C.; Flack, John M.; Fleg, Jerome L.; Katzen, Barry T.; Kostis, John B.; Oparil, Suzanne; Patel, Chet B.; Pepine, Carl J.; Piña, Ileana L.; Rocha-Singh, Krishna J.; Townsend, Raymond R.; Peterson, Eric D.; Califf, Robert M.; Patel, Manesh R.

In: American Heart Journal, Vol. 167, No. 6, 01.01.2014.

Research output: Contribution to journalArticle

Vemulapalli, S, Ard, J, Bakris, GL, Bhatt, DL, Brown, AS, Cushman, W, Ferdinand, KC, Flack, JM, Fleg, JL, Katzen, BT, Kostis, JB, Oparil, S, Patel, CB, Pepine, CJ, Piña, IL, Rocha-Singh, KJ, Townsend, RR, Peterson, ED, Califf, RM & Patel, MR 2014, 'Proceedings from Duke resistant hypertension think tank', American Heart Journal, vol. 167, no. 6. https://doi.org/10.1016/j.ahj.2014.02.008
Vemulapalli, Sreekanth ; Ard, Jamy ; Bakris, George L. ; Bhatt, Deepak L. ; Brown, Alan S. ; Cushman, William ; Ferdinand, Keith C. ; Flack, John M. ; Fleg, Jerome L. ; Katzen, Barry T. ; Kostis, John B. ; Oparil, Suzanne ; Patel, Chet B. ; Pepine, Carl J. ; Piña, Ileana L. ; Rocha-Singh, Krishna J. ; Townsend, Raymond R. ; Peterson, Eric D. ; Califf, Robert M. ; Patel, Manesh R. / Proceedings from Duke resistant hypertension think tank. In: American Heart Journal. 2014 ; Vol. 167, No. 6.
@article{230b318f9e8147809050a93413ab1b5c,
title = "Proceedings from Duke resistant hypertension think tank",
abstract = "To identify patients at increased risk for cardiovascular outcomes, apparent treatment resistant hypertension (aTRH) is defined as having a blood pressure (BP) above goal despite the use of ≥3 antihypertensive therapies of different classes at maximally tolerated doses, ideally including a diuretic. In light of growing scientific interest in the treatment of this group, a multistakeholder think tank was convened to discuss the current state of knowledge, improve the care of these patients, and identify appropriate study populations for future observational and randomized trials in the field. Although recent epidemiologic studies in selected populations estimate that the prevalence of aTRH is 10{\%} to 15{\%} of hypertensive patients, further large-scale observational studies will be needed to better elucidate risk factors. To spur the development of therapies for aTRH, the development of an {"}aTRH{"} label for pharmacologic and device therapies with a developmental pathway including treatment added to the use of existing therapies is favored. Although demonstration of adequate BP lowering should be sufficient to gain Food and Drug Administration approval for therapies targeting aTRH, assessment of improvement in quality of life and cardiovascular outcomes is also desirable and considered in Centers for Medicare and Medicaid Services coverage decisions. Device trials under the aTRH label will need uniform and consistent processes for defining appropriate patient populations as well as postapproval registries assessing both long-term safety and duration of responses. Finally, patients with aTRH are likely to benefit from evaluation by a hypertension team to assure proper patient identification, diagnostic work-up, and therapeutic management before consideration of advanced or novel therapies to lower BP.",
author = "Sreekanth Vemulapalli and Jamy Ard and Bakris, {George L.} and Bhatt, {Deepak L.} and Brown, {Alan S.} and William Cushman and Ferdinand, {Keith C.} and Flack, {John M.} and Fleg, {Jerome L.} and Katzen, {Barry T.} and Kostis, {John B.} and Suzanne Oparil and Patel, {Chet B.} and Pepine, {Carl J.} and Pi{\~n}a, {Ileana L.} and Rocha-Singh, {Krishna J.} and Townsend, {Raymond R.} and Peterson, {Eric D.} and Califf, {Robert M.} and Patel, {Manesh R.}",
year = "2014",
month = "1",
day = "1",
doi = "10.1016/j.ahj.2014.02.008",
language = "English (US)",
volume = "167",
journal = "American Heart Journal",
issn = "0002-8703",
publisher = "Mosby Inc.",
number = "6",

}

TY - JOUR

T1 - Proceedings from Duke resistant hypertension think tank

AU - Vemulapalli, Sreekanth

AU - Ard, Jamy

AU - Bakris, George L.

AU - Bhatt, Deepak L.

AU - Brown, Alan S.

AU - Cushman, William

AU - Ferdinand, Keith C.

AU - Flack, John M.

AU - Fleg, Jerome L.

AU - Katzen, Barry T.

AU - Kostis, John B.

AU - Oparil, Suzanne

AU - Patel, Chet B.

AU - Pepine, Carl J.

AU - Piña, Ileana L.

AU - Rocha-Singh, Krishna J.

AU - Townsend, Raymond R.

AU - Peterson, Eric D.

AU - Califf, Robert M.

AU - Patel, Manesh R.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - To identify patients at increased risk for cardiovascular outcomes, apparent treatment resistant hypertension (aTRH) is defined as having a blood pressure (BP) above goal despite the use of ≥3 antihypertensive therapies of different classes at maximally tolerated doses, ideally including a diuretic. In light of growing scientific interest in the treatment of this group, a multistakeholder think tank was convened to discuss the current state of knowledge, improve the care of these patients, and identify appropriate study populations for future observational and randomized trials in the field. Although recent epidemiologic studies in selected populations estimate that the prevalence of aTRH is 10% to 15% of hypertensive patients, further large-scale observational studies will be needed to better elucidate risk factors. To spur the development of therapies for aTRH, the development of an "aTRH" label for pharmacologic and device therapies with a developmental pathway including treatment added to the use of existing therapies is favored. Although demonstration of adequate BP lowering should be sufficient to gain Food and Drug Administration approval for therapies targeting aTRH, assessment of improvement in quality of life and cardiovascular outcomes is also desirable and considered in Centers for Medicare and Medicaid Services coverage decisions. Device trials under the aTRH label will need uniform and consistent processes for defining appropriate patient populations as well as postapproval registries assessing both long-term safety and duration of responses. Finally, patients with aTRH are likely to benefit from evaluation by a hypertension team to assure proper patient identification, diagnostic work-up, and therapeutic management before consideration of advanced or novel therapies to lower BP.

AB - To identify patients at increased risk for cardiovascular outcomes, apparent treatment resistant hypertension (aTRH) is defined as having a blood pressure (BP) above goal despite the use of ≥3 antihypertensive therapies of different classes at maximally tolerated doses, ideally including a diuretic. In light of growing scientific interest in the treatment of this group, a multistakeholder think tank was convened to discuss the current state of knowledge, improve the care of these patients, and identify appropriate study populations for future observational and randomized trials in the field. Although recent epidemiologic studies in selected populations estimate that the prevalence of aTRH is 10% to 15% of hypertensive patients, further large-scale observational studies will be needed to better elucidate risk factors. To spur the development of therapies for aTRH, the development of an "aTRH" label for pharmacologic and device therapies with a developmental pathway including treatment added to the use of existing therapies is favored. Although demonstration of adequate BP lowering should be sufficient to gain Food and Drug Administration approval for therapies targeting aTRH, assessment of improvement in quality of life and cardiovascular outcomes is also desirable and considered in Centers for Medicare and Medicaid Services coverage decisions. Device trials under the aTRH label will need uniform and consistent processes for defining appropriate patient populations as well as postapproval registries assessing both long-term safety and duration of responses. Finally, patients with aTRH are likely to benefit from evaluation by a hypertension team to assure proper patient identification, diagnostic work-up, and therapeutic management before consideration of advanced or novel therapies to lower BP.

UR - http://www.scopus.com/inward/record.url?scp=84901776143&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84901776143&partnerID=8YFLogxK

U2 - 10.1016/j.ahj.2014.02.008

DO - 10.1016/j.ahj.2014.02.008

M3 - Article

C2 - 24890525

AN - SCOPUS:84901776143

VL - 167

JO - American Heart Journal

JF - American Heart Journal

SN - 0002-8703

IS - 6

ER -