Health-related quality of life in persons with apparent treatment-resistant hypertension on at least four antihypertensives

Little is known about the impact of treatment-resistant hypertension (trh) on health-related quality of life (hrqol). we aimed to compare hrqol measures in adults with apparent trh (atrh) and non-resistant hypertension among nationally representative us medical expenditure panel survey data pooled from 2000 to 2011. cohorts compared were adults with atrh (⩾2 unique fills from ⩾4 antihypertensive classes during a year) versus non-resistant hypertension (those with hypertension not meeting the atrh definition). key outcomes were cohort differences in sf-12v2 physical component summary (pcs) and mental component summary (mcs) scores and disease-state utility using the sf-6d. of 57 150 adults with hypertension, 2501 (4.4%) met criteria for atrh. persons with atrh, compared with non-resistant hypertension, were older (mean, 68 vs 61 years), had a higher bmi (30.9 vs 29.7 kg m−2) and were more likely to be black (20% vs 14%), but less likely to be female (46% vs 54%). persons with atrh, compared with non-resistant hypertension, had lower mean pcs scores (35.8 vs 43.2; p<0.0001), and utility (0.68 vs 0.74; p<0.0001), but similar mcs scores (49.1 vs 50.4). in multivariable-adjusted analyses, atrh was associated with a 2.37 (95% ci 1.71 to 3.02) lower pcs score and 0.02 (95% ci 0.01 to 0.03) lower utility, compared with non-resistant hypertension. in conclusion, atrh was associated with substantially lower hrqol in physical functioning and health utility, but not in mental functioning, compared with non-resistant hypertension. the multivariable-adjusted reduction in physical functioning was similar in magnitude to previous observations comparing hypertension with no hypertension.