{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T15:13:19Z","timestamp":1787670799800,"version":"build-2736575974"},"reference-count":36,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,3,24]],"date-time":"2024-03-24T00:00:00Z","timestamp":1711238400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Clinical Hypertension"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Apparent treatment\u2010resistant hypertension (aTRH), defined as blood pressure (BP) that remains uncontrolled despite unconfirmed concurrent treatment with three\u00a0antihypertensives, is associated with an increased risk of developing cardiovascular and renal complications compared with controlled hypertension. We aimed to identify the characteristics of aTRH patients with an elevated risk of major adverse cardiovascular events plus (MACE+; defined as stroke, myocardial infarction, or heart failure hospitalization) and end stage renal disease (ESRD). This retrospective cohort study included aTRH patients (BP \u2265140\/90\u00a0mmHg and taking \u22653\u00a0antihypertensives) from the United States\u2013based Optum<jats:sup>\u00ae<\/jats:sup> de\u2010identified Electronic Health Record dataset and used machine learning models to identify risk factors of MACE+ or ESRD. Patients had claims for \u22653\u00a0antihypertensive classes within 30 days between January 1, 2015\u00a0and\u00a0June 30, 2021, and two office BP measures recorded 1\u201390 days apart within 30 days to 11 months after the index regimen date. Of a total 18\u00a0797 070 patients identified with any hypertension, 71\u00a0100 patients had aTRH. During the study period (mean 25.5 months), 4944 (7.0%) patients had a MACE+ and 2403 (3.4%) developed ESRD. In total, 22\u00a0risk factors were included in the MACE+ model and 16 in the ESRD model, and most were significantly associated with study outcomes. The risk factors with the largest impact on MACE+ risk were congestive heart failure, stages 4 and 5 chronic kidney disease (CKD), age \u226580\u00a0years, and living in the Southern region of the United States. The risk factors with the largest impact on ESRD risk, other than pre\u2010existing CKD, were anemia, congestive heart failure, and type 2 diabetes. The overall study cohort had a 5\u2010year predicted MACE+ risk of 13.4%; this risk was increased in those in the top 50% and 25% high\u2010risk groups (21.2% and 29.5%, respectively). The overall study cohort had a predicted 5\u2010year risk of ESRD of 6.8%, which was increased in the top 50% and 25% high\u2010risk groups (10.9% and 17.1%, respectively). We conclude that risk models developed in our study can reliably identify patients with aTRH at risk of MACE+ and ESRD based on information available in electronic health records; such models may be used to identify aTRH patients at high risk of adverse outcomes who may benefit from novel treatment interventions.<\/jats:p>","DOI":"10.1111\/jch.14791","type":"journal-article","created":{"date-parts":[[2024,3,25]],"date-time":"2024-03-25T06:58:20Z","timestamp":1711349900000},"page":"500-513","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Prediction of cardiovascular and renal risk among patients with apparent treatment\u2010resistant hypertension in the United States using machine learning methods"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1183-1267","authenticated-orcid":false,"given":"George","family":"Bakris","sequence":"first","affiliation":[{"name":"University of Chicago Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pei (Paul)","family":"Lin","sequence":"additional","affiliation":[{"name":"Janssen Scientific Affairs, LLC  Titusville New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang","family":"Xu","sequence":"additional","affiliation":[{"name":"Janssen Scientific Affairs, LLC  Titusville New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cindy","family":"Chen","sequence":"additional","affiliation":[{"name":"Janssen Scientific Affairs, LLC  Titusville New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4880-1897","authenticated-orcid":false,"given":"Veronica","family":"Ashton","sequence":"additional","affiliation":[{"name":"Janssen Scientific Affairs, LLC  Titusville New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mukul","family":"Singhal","sequence":"additional","affiliation":[{"name":"Janssen Scientific Affairs, LLC  Titusville New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,3,24]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"e53","DOI":"10.1161\/HYP.0000000000000084","article-title":"Resistant hypertension: detection, evaluation, and management: a scientific statement from the American Heart Association","volume":"72","author":"Carey RM","year":"2018","journal-title":"Hypertension"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.19043"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2015.230"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.122.19373"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cnc.2022.08.002"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/jch.12237"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001052"},{"key":"e_1_2_10_9_1","unstructured":"Centers for Disease Control and Prevention (CDC).Million Hearts. 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