Urinary Sodium and Incident Apparent Treatment-Resistant Hypertension among African American adults: The JHS

Hypertension is a leading cause of cardiovascular disease and disproportionately affects African American (AA) adults. Apparent treatment-resistant hypertension (aTRH) is highly prevalent in this population. Sodium intake is associated with blood pressure (BP) levels, yet the relationship between sodium and aTRH in AA adults remains unclear. This study examined the association between 24-hour urinary sodium excretion and incident aTRH among AA adults with hypertension, using data from the Jackson Heart Study (JHS). The JHS included 5,306 self-identified AA adults from Jackson, Mississippi, with data collected from 2000 to 2013. This analysis included 452 participants with baseline hypertension and complete urinary excretion and medication data. Sodium excretion was categorized into quartiles based on their urinary excretion: Q1 (253 to 2530 mg/day), Q2 (2553 to 3657 mg/day), Q3 (3680 to 4692 mg/day), and Q4 (4715 to 9775 mg/day). aTRH was defined as uncontrolled BP while taking ≥3 antihypertensive medications. A semi-parametric proportional hazards model was used to determine the association between sodium excretion and aTRH, adjusting for confounders. Participants in the current analyses were 63 years old on average and 27.7% men. Over a median follow-up of 7.5 years, 123 participants (27.2%) developed aTRH. Participants in Q3 and Q4 of sodium excretion showed higher incidence of aTRH, though fully adjusted hazard ratios were not statistically significant [HRs (95% confidence intervals [CIs]): [Q2=0.71 (0.34, 1.46), Q3=1.02 (0.50, 2.06), Q4=0.95 (0.46, 2.00); P=0.166). There was no statistically significant association between urinary sodium and incident aTRH among AA adults with hypertension.