PI-097 - CHARACTERIZING ANTIHYPERTENSIVE MEDICATION USAGE IN APPARENT TREATMENT-RESISTANT HYPERTENSION (aTRH) PATIENTS WITHIN THE STATE OF FLORIDA USING ELECTRONIC HEALTH RECORD (EHR)-BASED DATA.

E. Jafari, D. Truong, I. Wilson, R. Williams, R. Cooper-DeHoff, W. Hogan, C. McDonough; University of Florida, Gainesville, FL, USA.

Background: aTRH is defined as blood pressure (BP) above goal despite using ≥ 3 antihypertensive (anti-HTN) classes or controlled BP with ≥ 4 anti-HTN classes. The ideal combination therapy for aTRH recommended by the American Heart Association scientific statement includes angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), thiazide diuretics, and aldosterone antagonists as an add-on. However, the prescribing practice according to this statement in real-world populations is less explored.

Methods: We extracted HTN patients defined by ICD 9 and 10 codes during 1/1/2015-12/31/2018, from a large EHR database, the OneFlorida Data Trust (n=223,384). We applied our previously validated aTRH computable phenotype algorithm (BP goal < 140/90) and performed univariate and multivariate descriptive analysis to evaluate the prescribing patterns of anti-HTN combination therapy in aTRH patients prescribed ≥4 anti-HTN drugs.

Results: There were 26,142 (11.7%) aTRH patients included. The average age was 65 years, with 52% females, 42% white, and 38% black. Only ~2% were prescribed the guideline-recommended combination. 20% of patients were prescribed regimens that included ACEIs/ARBs, CCBs, thiazide diuretics, and BBs, as indicated by comorbidities. Additionally, 20% were prescribed regimens that included ACEIs/ARBs, CCBs, and thiazide diuretics, with 4th line drugs as potassium sparing diuretics (12%), alpha blockers (32%), loop diuretics (26%), vasodilators (14%), and centrally acting agents (14%).

Conclusion: We observed that most aTRH patients in Florida are not prescribed the most recent AHA statement recommended combination. However, many are prescribed regimens that include ACEIs/ARBs, CCBs, and thiazide diuretics.