# Determining true versus apparent treatment-resistant hypertension among African Americans in the Jackson Heart Study

> **NIH NIH R56** · UNIVERSITY OF ALABAMA AT BIRMINGHAM · 2020 · $779,461

## Abstract

Abstract
African Americans (AAs) have a high prevalence of hypertension and suffer a disproportionately
high risk for cardiovascular disease compared to whites. Apparent treatment-resistant
hypertension (aTRH) is a severe form of hypertension defined as requiring ≥ 4 antihypertensive
medications to achieve blood pressure (BP) control. An estimated 9 million US adults have
aTRH. Given the rigorous clinical work-up needed to rule out pseudoresistance and therefore,
diagnose true TRH, the population prevalence of TRH is not known. We propose an ancillary
study to the Jackson Heart Study (JHS), a large prospective cohort of AA adults (n=5,306) that
will deeply phenotype participants with aTRH, ruling out pseudoresistance (i.e., inaccurate clinic
BP measurement, presence of a white coat effect, suboptimal antihypertensive therapy, and
poor medication adherence) and secondary causes of hypertension (i.e., primary aldosteronism,
obstructive sleep apnea, and kidney disease). The JHS provides a highly feasible setting for
the proposed study as it includes a large population of AAs with a high prevalence of
hypertension and extensive data collection as part of an upcoming fourth parent study visit,
which will facilitate the screening and recruitment of participants for our ancillary study. Based
on data collected during the fourth JHS exam, we will identify 400 cases with aTRH and 200
treatment-responsive controls. These participants will undergo a clinical evaluation for TRH
including ambulatory BP monitoring (ABPM) to detect white coat effect and urinalysis of
antihypertensive drug metabolites to assess medication adherence. We will compare
secondary causes of hypertension among aTRH cases and treatment-responsive controls. We
will screen for primary aldosteronism and kidney disease using blood and urine samples and
obstructive sleep apnea using home polysomnography. Finally, we will compare lifestyle factors
for participants with true TRH compared to controls. We will assess dietary sodium by
urinalysis, alcohol and non-steroidal anti-inflammatory drug use through questionnaires, and
physical activity through actigraphy. The proposed study will help identify adults who may
benefit from targeted therapies and lifestyle changes to improve health outcomes while avoiding
unnecessary clinic visits and wasted healthcare resources caused by over-treatment among
those with aTRH versus true TRH.

## Key facts

- **NIH application ID:** 10241783
- **Project number:** 1R56HL151687-01
- **Recipient organization:** UNIVERSITY OF ALABAMA AT BIRMINGHAM
- **Principal Investigator:** Rikki M Tanner
- **Activity code:** R56 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $779,461
- **Award type:** 1
- **Project period:** 2020-09-17 → 2024-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10241783

## Citation

> US National Institutes of Health, RePORTER application 10241783, Determining true versus apparent treatment-resistant hypertension among African Americans in the Jackson Heart Study (1R56HL151687-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10241783. Licensed CC0.

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