Public Health Commons^™

Recent Advances On The Molecular Mechanism And Clinical Trials Of Venous Thromboembolism, Shao-Li Huang, Hong-Yi Xin, Xiao-Yan Wang, Guang-Gui Feng, Fu-Qing Wu, Zhi-Peng Feng, Zhou Xing, Xi-He Zhang, Hong-Wu Xin, Wen-Ying Luo

Faculty, Staff and Student Publications

Venous thromboembolism is a condition that includes deep vein thrombosis and pulmonary embolism. It is the third most common cardiovascular disease behind acute coronary heart disease and stroke. Over the past few years, growing research suggests that venous thrombosis is also related to the immune system and inflammatory factors have been confirmed to be involved in venous thrombosis. The role of inflammation and inflammation-related biomarkers in cerebrovascular thrombotic disease is the subject of ongoing debate. P-selectin leads to platelet-monocyte aggregation and stimulates vascular inflammation and thrombosis. The dysregulation of miRNAs has also been reported in venous thrombosis, suggesting the involvement …

Developing And Pre-Testing A Digital Decision-Tree Smartphone Application For Smoking Prevention And Cessation Among Hiv Care Providers, Irene Tamí-Maury, Samuel Tundealao, Jenna Guzman, Valeri Noé-Díaz, Christine Markham, Karen Vigil

Faculty, Staff and Student Publications

OBJECTIVES: The diagnosis and continuous care of chronic conditions such as HIV infection present potential teachable moments for delivering smoking prevention and cessation interventions for patients. We designed and pre-tested a prototype of a smartphone application(app), Decision-T, specifically designed to assist healthcare providers when providing personalized smoking prevention and cessation services to their patients.

METHODS: We developed the Decision-T app based on transtheoretical algorithm for smoking prevention and cessation following the 5-A's model. We employed a mixed-methods approach among 18 HIV-care providers recruited from Houston Metropolitan Area for pre-testing the app. Each provider participated in three mock sessions, and the …

Expanding Medicaid To Reduce Human Immunodeficiency Virus Transmission In Houston, Texas: Insights From A Modeling Study, Francis Lee, Aditya S Khanna, Camden J Hallmark, Richa Lavingia, Marlene Mcneese, Jing Zhao, Melanie L Mcneese, Salma Khuwaja, Babak M Ardestani, Nicholson Collier, Jonathan Ozik, Anna L Hotton, Nina T Harawa, John A Schneider, Kayo Fujimoto

Faculty, Staff and Student Publications

CONTEXT: Medicaid expansion has been nationally shown to improve engagement in the human immunodeficiency virus (HIV) treatment and prevention continua, which are vital steps to stopping the HIV epidemic. New HIV infections in the United States are disproportionately concentrated among young Black men who have sex with men (YBMSM). Houston, TX, is the most populous city in the Southern United States with a racially/ethnically diverse population that is located in 1 of 11 US states that have not yet expanded Medicaid coverage as of 2021.

METHODS: An agent-based model that incorporated the sexual networks of YBMSM was used to simulate …

Angiotensin-Ii Stimulating Vs Inhibiting Antihypertensive Drugs And The Risk Of Alzheimer's Disease Or Related Dementia In A Large Cohort Of Older Patients With Colorectal Cancer, Xianglin L Du, Zhuoyun Li, Paul E Schulz

Faculty, Staff and Student Publications

BACKGROUND: Several previous studies showed that patients who received angiotensin II-stimulating antihypertensive medications had a lower incident dementia rate than those angiotensin II-inhibiting antihypertensive users, but no study has been conducted in long-term cancer survivors.

OBJECTIVES: to determine the risk of Alzheimer's disease (AD) and related dementia (ADRD) associated with the types of antihypertensive medications in a large cohort of survivors with colorectal cancer in 2007-2015 with follow-up from 2007 to 2016.

METHODS: We identified 58,699 men and women with colorectal cancer aged 65 or older from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database in 17 SEER areas …

Revisiting Exclusion Of Prior Cancer In Clinical Trials Of Male Breast Cancer, Aniruddha Rathod, Caitlin C Murphy, Asal Rahimi, Sandi L Pruitt

Faculty, Staff and Student Publications

Background: Eligibility criteria for cancer clinical trials present challenges to enrollment. Many trials exclude patients with a prior cancer. This common practice may be especially detrimental to trials of rare cancers, such as male breast cancer, that struggle to accrue adequate numbers of participants. Objectives: to estimate prevalence of prior cancer among men newly diagnosed with breast cancer and describe characteristics of men with prior cancer compared to those without. Methods: We identified men diagnosed with breast cancer between 2011-2015 using population-based data from National Cancer Institute's Surveillance, Epidemiology, and End Results program of cancer registries. We used sequence number …

A Coalition-Driven Examination Of Organization Capacity To Address Food Insecurity In Greater Houston: A Qualitative Research Study, Jemima C John, Jennifer Gonzalez, Sara-Grace Chan, Heidi Mcpherson, Jennifer N Aiyer, Esperanza Galvan, Nicole Browning, Shreela V Sharma

Faculty, Staff and Student Publications

BACKGROUND: Economic and social hardships have worsened food insecurity, particularly among low income and racial-ethnic minority groups. Given the core goal of the 150+ member Houston Health Equity Collective (HEC) to reduce food insecurity by 5% in 2025, we explored member organizations' capacity and challenges faced in screening and responding to food insecurity through care coordination efforts.

METHODS: A twice-administered Qualtrics XM survey (Provo, Utah) with 76 organizations, followed by five focus groups with 22 of these organizations, explored reach and response efforts to food insecurity. Qualitative assessments lasted between 0.5 to 1.5 h, were audio-recorded, cleaned, coded, and thematically …

Using Implementation Mapping To Increase Uptake And Use Of Salud En Mis Manos: A Breast And Cervical Cancer Screening And Hpv Vaccination Intervention For Latinas, Lara S Savas, Preena Loomba, Ross Shegog, Angelita Alaniz, Crystal Costa, Emily Adlparvar, Marlyn A Allicock, Roshanda Chenier, Margaret Goetz, Christine M Markham, Maria E Fernandez

Faculty, Staff and Student Publications

BACKGROUND: Despite CDC recommendations for breast and cervical cancer screening and HPV vaccination, cancer control behaviors are underutilized among low-income Latinas.

METHODS: We used Implementation Mapping to create SEMM-Dissemination and Implementation Assistance (SEMM-DIA), a set of implementation strategies designed to support implementation and maintenance of SEMM in clinic settings. Specifically, we used Implementation Mapping's five iterative tasks to guide the use of theories and frameworks, evidence, new data, and stakeholder input to develop strategies to accelerate and improve implementation fidelity, reach, and maintenance of the SEMM intervention. The resulting implementation mapping logic model also guides the SEMM-DIA evaluation plan to …

A Student-Designed Multimodal Sex- And Gender-Based Women's Health Elective Program: Advocacy Curriculum For Medical Students, Lauren M Conroy, Danna Ghafir, Maitreyi Narayan, Hunter Mcspedden, Samuel Neher, S Shahrukh Hashmi, Rebecca Lunstroth

Faculty, Staff and Student Publications

OBJECTIVES: The objective of this article is to describe the design and implementation of a multimodal, student-driven, sex- and gender-based women's health (SGBWH) elective with a curricular focus on patient and legislative advocacy. In this single arm, pre/post design, interventional study, we detail and evaluate the use of social media, newsletters, and round-table discussions in conjunction with a traditional lecture-based educational format to engage medical students in a virtual learning environment.

METHODS: We developed a 22-week SGBWH curriculum for pre-clinical and clinical medical students, which included a series of lectures on multi-specialty and gender-inclusive topics related to SGBWH, small group …

Patterns Of Multiple Congenital Anomalies In The National Birth Defect Prevention Study: Challenges And Insights, Meredith M Howley, Eva Williford, A J Agopian, Angela E Lin, Lorenzo D Botto, Christopher M Cunniff, Paul A Romitti, Eirini Nestoridi, Marilyn L Browne

Faculty, Staff and Student Publications

Background: About 20%-30% of children with birth defects have multiple major birth defects in more than one organ system, often referred to as multiple congenital anomalies (MCAs). Evaluating the patterns of MCAs can provide clues to the underlying causes, pathogenic mechanisms, and developmental pathways. We sought to explore selected patterns of MCAs within the National Birth Defects Prevention Study (NBDPS), a population-based, case-control study that excluded cases attributed to known chromosomal or single-gene abnormalities.

Methods: We defined MCAs as having two or more NBDPS-eligible birth defects and calculated the adjusted observed-to-expected ratio for all observed MCA patterns using co-occurring defect …

Connecting Children With Birth Defects To Health And Social Service Programs: A Collaboration Between The Texas Birth Defects Registry And Agency Social Workers, Dayana Betancourt, Mark A Canfield, Mary K Ethen, Charles Shumate, Margaret Drummond-Borg, Christina Kubenka, Jessica Palacios, A J Agopian

Faculty, Staff and Student Publications

Background: Timely referral to services for children born with birth defects can improve health outcomes. Birth defects surveillance registries may be a valuable data source for connecting children to health and social service programs.

Methods: Population-based, state-wide data from the Texas Birth Defects Registry (TBDR) at the Texas Department of State Health Services (DSHS) were used to connect children 9-18 months old, born with select birth defects with DSHS social workers. The social workers reviewed developmental milestones and referred children and their families to various health and social service programs. We tabulated the proportions of children meeting milestones and referral …

Corrigendum: Application Of Implementation Mapping To Develop Strategies For Integrating The National Diabetes Prevention Program Into Primary Care Clinics, William B Perkison, Serena A Rodriguez, Fernanda Velasco-Huerta, Patenne D Mathews, Catherine Pulicken, Sidra S Beg, Natalia I Heredia, Pierre Fwelo, Grace E White, Belinda M Reininger, John W Mcwhorter, Roshanda Chenier, Maria E Fernandez

Faculty, Staff and Student Publications

This corrects the article "Application of implementation mapping to develop strategies for integrating the National Diabetes Prevention Program into primary care clinics", 933253.

Incidence Trends In Prostate Cancer Among Men In The United States From 2000 To 2020 By Race And Ethnicity, Age And Tumor Stage, Xianglin L Du, Daoqi Gao, Zhuoyun Li

Faculty, Staff and Student Publications

PURPOSE: to explore whether prostate cancer incidence trends from 2000 to 2020 in the United States differed by race and ethnicity, age and tumor stage; to explore racial differences in prostate cancer incidence change due to the impact of COVID-19 pandemic lockdown in 2020; and to determine if there is any high-risk population that can be targeted for prevention.

METHODS: We identified 1,098,349 men who were diagnosed with incident prostate cancer at age ≥20 in 2000-2020 in 17 registries of the Surveillance, Epidemiology, and End Results (SEER) program in the United States; of whom, 778,437 were non-Hispanic whites, 155,111 non-Hispanic …

Postoperative Pulmonary Complication As An Emerging Complication In Major Head And Neck Cancer Surgery: A Retrospective Study, Ritoban S Bhowmick, Aniket Sarkar, Samiran Ghosh, Shamik Gope, Rittika Chakraborty

Faculty, Staff and Student Publications

PURPOSE: Postoperative pulmonary complications (PPCs) are one of the most significant complications following head and neck cancer surgery (HNCS). Patients requiring tracheostomy, free tissue transfer reconstruction, and postoperative ventilation in an intensive care unit (ICU) may have a high incidence of PPCs. This study aimed to identify the most likely situations for developing PPCs in HNCS.

MATERIALS AND METHODS: A retrospective analysis of 40 patients who had undergone HNCS has been conducted. We individually traced each patient for 7 days postoperatively and collected data on various parameters.

RESULT: The incidence of PPCs after HNCS is more with free flap reconstruction. …

A More Powerful Test For Three-Arm Non-Inferiority Via Risk Difference: Frequentist And Bayesian Approaches, Erina Paul, Ram C Tiwari, Shrabanti Chowdhury, Samiran Ghosh

Faculty, Staff and Student Publications

Necessity for finding improved intervention in many legacy therapeutic areas are of high priority. This has the potential to decrease the expense of medical care and poor outcomes for many patients. Typically, clinical efficacy is the primary evaluating criteria to measure any beneficial effect of a treatment. Albeit, there could be situations when several other factors (e.g. side-effects, cost-burden, less debilitating, less intensive, etc.) which can permit some slightly less efficacious treatment options favorable to a subgroup of patients. This often leads to non-inferiority (NI) testing. NI trials may or may not include a placebo arm due to ethical reasons. …

Genome-Wide Mendelian Randomization Identifies Putatively Causal Gut Microbiota For Multiple Peptic Ulcer Diseases, Jingwei Zhao, Yucheng Hou, Tianyi Xie, Yizhang Zhu, Xinyi Feng, Yong Zhang, Ziyi Yang, Wei Gong

Faculty, Staff and Student Publications

OBJECTIVE: The pathogenesis of peptic ulcer diseases (PUDs) involves multiple factors, and the contribution of gut microbiota to this process remains unclear. While previous studies have associated gut microbiota with peptic ulcers, the precise nature of the relationship, whether causal or influenced by biases, requires further elucidation.

DESIGN: The largest meta-analysis of genome-wide association studies was conducted by the MiBioGen consortium, which provided the summary statistics of gut microbiota for implementation in the Mendelian randomization (MR) analysis. Summary statistics for five types of PUDs were compiled using the FinnGen Consortium R8 release data. Various statistical techniques, including inverse variance weighting …

2024 Annual Report, Evidence To Practice, Cep Annual Reports, Lisa Staples, Tommy Nguyen, Brooke Dupre, Alice Yeh, G. Gonzalez, Stephen Phillippi

Policy & Position Papers

No abstract provided.

Regional Outbreak Of Multidrug-Resistant Klebsiella Pneumoniae Carbapenemase-Producing Pseudomonas Aeruginosa, Bekana K Tadese, Anna Nutt, Ifrah Chaudhary, Charlene Offiong, Charles Darkoh

Faculty, Staff and Student Publications

Klebsiella pneumoniae carbapenemase-producing P. aeruginosa (KPC-CRPA) are rare in the United States. An outbreak of KPC-CRPA was investigated in Texas using molecular and epidemiologic methods and 17 cases of KPC-CRPA were identified. The isolates were genetically related and harbored the emerging P. aeruginosa multilocus sequence type 235, the first in the United States.

Incidence Trends In Triple-Negative Breast Cancer Among Women In The United States From 2010 To 2019 By Race/Ethnicity, Age And Tumor Stage, Xianglin L Du, Zhuoyun Li

Faculty, Staff and Student Publications

There were substantial ethnic disparities in the incidence rates of triple-negative breast cancer, but few studies were conducted on the incidence trend of triple-negative breast cancer by race/ethnicity. This study aimed to address the longer trends in the incidence of triple-negative breast cancer by race/ethnicity in women from 2010 to 2019, examine the incidence trends by patient age, tumor stage and time periods, and explore the changing proportions of three component receptors over time for triple-negative breast cancer. Our study identified 573,168 women with incident breast cancer at age ≥20 years between 2010 and 2019 in 18 SEER (Surveillance, Epidemiology, …

Toward A More Comprehensive Understanding Of Organizational Influences On Implementation: The Organization Theory For Implementation Science Framework, Sarah A Birken, Cheyenne R Wagi, Alexandra G Peluso, Michelle C Kegler, Jure Baloh, Prajakta Adsul, Maria E Fernandez, Manal Masud, Terry T-K Huang, Matthew Lee, Mary Wangen, Per Nilsen, Miriam Bender, Mimi Choy-Brown, Grace Ryan, Aliza Randazzo, Linda K Ko

Faculty, Staff and Student Publications

INTRODUCTION: Implementation is influenced by factors beyond individual clinical settings. Nevertheless, implementation research often focuses on factors related to individual providers and practices, potentially due to limitations of available frameworks. Extant frameworks do not adequately capture the myriad organizational influences on implementation. Organization theories capture diverse organizational influences but remain underused in implementation science. to advance their use among implementation scientists, we distilled 70 constructs from nine organization theories identified in our previous work into theoretical domains in the Organization Theory for Implementation Science (OTIS) framework.

METHODS: The process of distilling organization theory constructs into domains involved concept mapping and …

Health-Related Quality Of Life And Recovery Capital Among Recovery Residents Taking Medication For Opioid Use Disorder In Texas, Elizabeth O Obekpa, Sheryl A Mccurdy, Vanessa Schick, Christine M Markham, Kathryn R Gallardo, Johnny Michael Wilkerson

Faculty, Staff and Student Publications

BACKGROUND: Recovery from opioid use disorder (OUD) includes improvements in health-related quality of life (HRQOL) and is supported by recovery capital (RC). Little is known about RC and HRQOL among recovery residents taking medication for OUD. We described HRQOL and RC and identified predictors of HRQOL.

METHODS: Project HOMES is an ongoing longitudinal study implemented in 14 recovery homes in Texas. This is a cross-sectional analysis of data from 358 participants' on HRQOL (five EQ-5D-5L dimensions-mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) and RC (Assessment of Recovery Capital scores) collected from April 2021 to June 2023. Statistical analyses were conducted …

Observed And Perceived Benefits Of Providing Physical Activity Opportunities In Elementary Schools: A Qualitative Study, Timothy J Walker, Derek W Craig, Christopher D Pfledderer, Michael C Robertson, Paula Cuccaro, Keisey Fumero, John B Bartholomew

Faculty, Staff and Student Publications

INTRODUCTION: Schools play an important role in promoting physical activity for youth. However, school-based physical activity opportunities often compete with other academic priorities, limiting their implementation. The purpose of this study was to qualitatively explore elementary school teacher and staff perspectives on providing physical activity opportunities and how they impact students and learning.

METHODS: We partnered with a school district in Texas to conduct semi-structured individual interviews. We used a purposeful sampling approach to recruit elementary teachers and staff knowledgeable about the physical activity opportunities provided at their school. Interviews included questions about participant opinions of providing physical activity opportunities …

Elementary School Staff Perspectives On The Implementation Of Physical Activity Approaches In Practice: An Exploratory Sequential Mixed Methods Study, Timothy J Walker, Christopher D Pfledderer, Derek W Craig, Michael C Robertson, Natalia I Heredia, John B Bartholomew

Faculty, Staff and Student Publications

INTRODUCTION: A whole-of-school approach is best to promote physical activity before, during, and after school. However, multicomponent programming is often complex and difficult to deliver in school settings. There is a need to better understand how components of a whole-of-school approach are implemented in practice. The objectives of this mixed methods study were to: (1) qualitatively explore physical activity approaches and their implementation in elementary schools, (2) quantitatively assess implementation levels, and (3) examine associations between school-level physical activity promotion and academic ratings.

METHODS: We used an exploratory sequential mixed methods design. We conducted semi-structured qualitative interviews with elementary school …

Do Breast Cancer Survivors With A Recent History Of Clinical Depression Report Worse Experiences With Care? A Retrospective Cohort Study Using Seer-Cahps Data, Mariana Arevalo, Trevor A Pickering, Sally W Vernon, Kayo Fujimoto, Melissa F Peskin, Albert J Farias

Faculty, Staff and Student Publications

PURPOSE: We examined whether breast cancer survivors' experiences with care differed by a recent history of clinical depression, and whether associations differed by race/ethnicity.

METHODS: Using the Epidemiology and End Results-Consumer Assessment of Healthcare Providers and Systems (SEER-CAHPS) dataset, we analyzed records of breast cancer survivors who completed a survey at least 12 months after their cancer diagnosis. We assessed clinical depression 12 months prior to survey completion using Medicare claims. We used separate multivariable logistic regressions to examine the associations between depression and excellent (vs. less than excellent) ratings of experiences with care (i.e., doctor communication, getting needed care, …

Semiparametric Regression Modeling Of The Global Percentile Outcome, Xiangyu Liu, Jing Ning, Xuming He, Barbara C Tilley, Ruosha Li

Faculty, Staff and Student Publications

When no single outcome is sufficient to capture the multidimensional impairments of a disease, investigators often rely on multiple outcomes for comprehensive assessment of global disease status. Methods for assessing covariate effects on global disease status include the composite outcome and global test procedures. One global test procedure is the O'Brien's rank-sum test, which combines information from multiple outcomes using a global rank-sum score. However, existing methods for the global rank-sum do not lend themselves to regression modeling. We consider sensible regression strategies for the global percentile outcome (GPO), under the transformed linear model and the monotonic index model. Posing …

Biomimetic Copper-Doped Polypyrrole Nanoparticles For Enhanced Cancer Low-Temperature Photothermal Therapy, Hao Chen, Xi Luo, Wei Cai, Shile Wang, Jingfeng Xiang, Zeming Liu, Daoming Zhu

Faculty, Staff and Student Publications

INTRODUCTION: Photothermal therapy (PTT) has a significant potential for its application in precision tumour therapy. However, PTT-induced hyperthermia may damage healthy tissues and trigger the expression of heat shock proteins (HSPs), thereby compromising the long-term therapeutic efficacy of PTT.

METHODS: In this study, a biomimetic drug delivery system comprising CuP nanozymes as the inner core and platelet membrane (PM) as the outer shell was successfully developed for administering synergistic chemodynamic therapy and mild PTT. PM is encapsulated on CuP to form this biomimetic nanoparticle (PM-coated CuP nanoparticles, PC). PC possesses peroxidase (POD) activity, can facilitate the conversion of hydrogen peroxide …

The 18-Year Risk Of Cancer, Angioedema, Insomnia, Depression, And Erectile Dysfunction In Association With Antihypertensive Drugs: Post-Trial Analyses From Allhat-Medicare Linked Data, Xianglin L Du, Journey Martinez, Jose-Miguel Yamal, Lara M Simpson, Barry R Davis

Faculty, Staff and Student Publications

PURPOSE: This study aimed to determine the 18-year risk of cancer, angioedema, insomnia, depression, and erectile dysfunction in association with antihypertensive drug use.

METHODS: This is a post-trial passive follow-up study of Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) participants between 1994 and 1998 that was conducted by linking their follow-up data with Medicare claims data until 2017 of subjects who were free of outcomes at baseline on 1 January 1999. The main outcomes were the occurrence of cancer (among

RESULTS: The 18-year cumulative incidence rate of cancer other than non-melanoma skin cancer from Medicare inpatient claims …

Understanding The Implications Of Under-Reporting, Vaccine Efficiency And Social Behavior On The Post-Pandemic Spread Using Physics Informed Neural Networks: A Case Study Of China, Samiran Ghosh, Alonso Ogueda-Oliva, Aditi Ghosh, Malay Banerjee, Padmanabhan Seshaiyer

Faculty, Staff and Student Publications

In late 2019, the emergence of COVID-19 in Wuhan, China, led to the implementation of stringent measures forming the zero-COVID policy aimed at eliminating transmission. Zero-COVID policy basically aimed at completely eliminating the transmission of COVID-19. However, the relaxation of this policy in late 2022 reportedly resulted in a rapid surge of COVID-19 cases. The aim of this work is to investigate the factors contributing to this outbreak using a new SEIR-type epidemic model with time-dependent level of immunity. Our model incorporates a time-dependent level of immunity considering vaccine doses administered and time-post-vaccination dependent vaccine efficacy. We find that vaccine …

A Satellite-Driven Model To Estimate Long-Term Particulate Sulfate Levels And Attributable Mortality Burden In China, Xia Meng, Yun Hang, Xiuran Lin, Tiantian Li, Tijian Wang, Junji Cao, Qingyan Fu, Sagnik Dey, Kan Huang, Fengchao Liang, Haidong Kan, Xiaoming Shi, Yang Liu

Faculty, Staff and Student Publications

Ambient fine particulate matter (PM

Transcription Factor E2f1 Regulates The Expression Of Adrb2, Juan Du, Feifei Rui, Zhongfen Hao, Yun Hang, Jin Shu

Faculty, Staff and Student Publications

Adrenergic beta-2-receptor (ADRB2) is highly expressed in various tissue cells, affecting the susceptibility, development, and drug efficacy of diseases such as bronchial asthma and malignant tumor. However, the transcriptional regulatory mechanism of the human ADRB2 gene remains unclear. This study aimed to clarify whether E2F transcription factor 1 (E2F1) was involved in the transcriptional regulation of the human ADRB2 gene. First, the 5' flanking region of the human ADRB2 gene was cloned, and its activity was detected using A549 and BEAS-2B cells. Second, it was found that the overexpression of E2F1 could increase promoter activity by a dual-luciferase reporter gene …

Whole Genome Sequence Analysis Of Apparent Treatment Resistant Hypertension Status In Participants From The Trans-Omics For Precision Medicine Program, Nicole D Armstrong, Vinodh Srinivasasainagendra, Farah Ammous, Themistocles L Assimes, Amber L Beitelshees, Jennifer Brody, Brian E Cade, Yii-Der Ida Chen, Han Chen, Paul S De Vries, James S Floyd, Nora Franceschini, Xiuqing Guo, Jacklyn N Hellwege, John S House, Chii-Min Hwu, Sharon L R Kardia, Ethan M Lange, Leslie A Lange, Caitrin W Mcdonough, May E Montasser, Jeffrey R O'Connell, Megan M Shuey, Xiao Sun, Rikki M Tanner, Zhe Wang, Wei Zhao, April P Carson, Todd L Edwards, Tanika N Kelly, Eimear E Kenny, Charles Kooperberg, Ruth J F Loos, Alanna C Morrison, Alison Motsinger-Reif, Bruce M Psaty, Dabeeru C Rao, Susan Redline, Stephen S Rich, Jerome I Rotter, Jennifer A Smith, Albert V Smith, Marguerite R Irvin, Donna K Arnett

Faculty, Staff and Student Publications

Introduction: Apparent treatment-resistant hypertension (aTRH) is characterized by the use of four or more antihypertensive (AHT) classes to achieve blood pressure (BP) control. In the current study, we conducted single-variant and gene-based analyses of aTRH among individuals from 12 Trans-Omics for Precision Medicine cohorts with whole-genome sequencing data.

Methods: Cases were defined as individuals treated for hypertension (HTN) taking three different AHT classes, with average systolic BP ≥ 140 or diastolic BP ≥ 90 mmHg, or four or more medications regardless of BP (n = 1,705). A normotensive control group was defined as individuals with BP < 140/90 mmHg (n = 22,079), not on AHT medication. A second control group comprised individuals who were treatment responsive on one AHT medication with BP < 140/ 90 mmHg (n = 5,424). Logistic regression with kinship adjustment using the Scalable and Accurate Implementation of Generalized mixed models (SAIGE) was performed, adjusting for age, sex, and genetic ancestry. We assessed variants using SKAT-O in rare-variant analyses. Single-variant and gene-based tests were conducted in a pooled multi-ethnicity stratum, as well as self-reported ethnic/racial strata (European and African American).

Results: One variant in …