Structure of patients with resistant arterial hypertension

O.L. Rekovets, O.O. Torbas, S.M. Kushnir, G.V. Ponomareva, G.F. Primak, V.M. Granich, N.A. Krushynskaya, S.A. Polishchuk, P.I. Sidorenko, Yu.M. Sirenko

Abstract


Background. Patients with uncontrolled blood pressure (BP) have a fourfold increase in the risk of developing cardiovascular events compared to those with hypertension who have reached the target blood pressure. The purpose of the study was to evaluate the structural characteristics of patients with resistant arterial hypertension (AH) undergoing in-patient treatment at the department of symptomatic hypertensions of the SI “NSC “M.D. Strazhesko Institute of Cardiology” of the National Academy of Medical Sciences of Ukraine” and to determine the achievement of the target blood pressure in patients with resistant AH taking three or more antihypertensive drugs. Materials and methods. The study included 1,146 patients with resistant AH who received 3 or more antihypertensive drugs and were treated at the department of symptomatic hypertensions of the SI “NSC “M.D. Strazhesko Institute of Cardiology” of the National Aca-demy of Medical Sciences of Ukraine”. The level of office BP at admission to the department was ≥ 140/90 mmHg if patients took 3 or more AH drugs. The average level of systolic (SBP)/diastolic blood pressure (DBP) was 174.60 ± 0.64/100.50 ± 0.38 mmHg. Patients underwent the following examinations: body height and weight measurements, office BP, daily blood pressure monitoring, echocardiography, pulse wave velocity and central blood pressure, sleep apnea determination, general blood count, blood biochemical analysis, evaluating the levels of thyroid-stimulating hormone, Т3, Т4, blood renin, blood aldosterone and their correlation, determination of urine metanephrine, cortisol. Results. Among patients with resistant arterial hypertension, there were more women (63 %) than men (37 %). Secondary hypertension was found in 5 %; renoparenchymal arterial hypertension, adrenocortical adenoma with hyperaldesononism and abnormal thyroid function with hypothyroidism predominated in the structure. 16.6 % of patients with resistant arterial hypertension had type 2 diabetes mellitus, 15.8 % — a history of cerebrovascular accident, with an ischemic stroke prevalence of 12.8 %. Patients who did not achieve target SBP (31 %) had significantly higher blood pressure at admission. They had a significantly higher blood cortisol level (155.0 ± 44.0 ng/l vs 35.9 ± 20.8 ng/l), higher left ventricular mass index (147.50 ± 3.46 g/m2 vs 135.30 ± 1.74 g/m2), obesity (42.9 vs 37.5 %), kidney abnormality (2.7 vs 0.8 %), obliterating lower limb atherosclerosis (2.0 vs 0.2 %), structural alterations in the adrenal gland (3.0 vs 1.2 %), nephropathy (1.3 vs 0.2 %), and higher degree of heart failure (16.9 vs 8.5 %). The degree of office blood pressure reduction among patients who received 3 or more drugs was 43.47 ± 0.65 mmHg for SBP and 20.33 ± 0.74 mmHg for DBP, p < 0.001 for both values. The DBP did not differ significantly between patients taking 3 and 4 drugs or more — 19.88 and 20.81 mmHg, respectively, and the office SBP significantly decreased in patients taking 4 drugs or more — by 45.78 mmHg compared with the group taking 3 drugs — 41.3 mmHg, p < 0.001. Conclusions. Secondary arterial hypertension was found in 5 % of patients with resistant hypertension; renoparenchymal hypertension, adrenocortical adenoma with hyperaldesononism and abnormal thyroid function with hypothyroidism prevailed in the structure.


Keywords


resistance arterial hypertension; secondary arterial hypertension; target blood pressure

References


Горбась І.М., Смирнова І.П., Вакалюк І.П. та ін. Епідеміологічна ситуація щодо артеріальної гіпертензії у сільській популяції України // Ліки України. — 2013. — № 7. — С. 88-91.

Кваша Е.А., Горбась И.М., Смирнова И.П., Срибная И.В. Артериальная гипертензия: 35-летняя динамика распространенности и эффективности ее контроля на популяционном уровне среди мужчин, проживающих в городе // Артериальная гипертензия. — 2016. — № 3. — С. 18-23.

Hwang A.Y., Dietrich E., Pepine C.J., Smith S.M. Resistant Hypertension: Mechanisms and Treatment // Curr. Hypertens Rep. — 2017. — 19. — 56. doi: 10.1007/s11906-017-0754-x.

Bangalore S., Fayyad R., Laskey R. et al. Prevalence, predictors, and outcomes in treatment-resistant hypertension in patients with coronary disease // Am. J. Med. — 2014. — 127(1). — Р. 71-81. — e71.

Benjamin E.J., Blaha M.J., Chiuve S.E. et al. Heart di-sease and stroke statistics — 2017 update: a report from the American Heart Association // Circulation. — 2017.

Brandani L. Resistant hypertension: a therapeutic challenge // J. Clin. Hypertens. — 2018. — 20. — С. 76-78.

Calhoun D.A., Jones D., Textor S. et al. Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research // Circulation. — 2008. — 117(25). — Р. 510-526.

Carris N.W., Ghushchyan V., Libby A.M., Smith S.M. Health-related quality of life in persons with apparent treatment-resistant hypertension on at least four antihypertensives // J. Hum. Hypertens. — 2016. — 30(3). — Р. 191-196.

Chobanian A.V., Bakris G.L., Black H.R. et al. The se­venth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report // JAMA. — 2003. — 289(19). — Р. 2560-2572.

Daugherty S.L., Powers J.D., Magid D.J. et al. Incidence and prognosis of resistant hypertension in hypertensive patients // Circulation. — 2012. — 125(13). — Р. 1635-1642.

Dudenbostel T., Acelajado M.C., Pisoni R., Li P., Oparil S., Calhoun D.A. Refractory hypertension: evidence of heightened sympathetic activity as a cause of antihypertensive treatment failure // Hypertension. — 2015. — 66(1). — Р. 126-133. This study identified several markers of elevated SNS activity associated with the refractory hypertension phenotype.

Dudenbostel T., Siddiqui M., Oparil S., Calhoun D.A. Refractory hypertension: a novel phenotype of antihypertensive treatment failure // Hypertension. — 2016. — 67(6). — Р. 1085-

Duprez D.A. Aldosterone and the vasculature: mechanisms mediating resistant hypertension // J. Clin. Hypertens (Greenwich). — 2007. — 9(1 Suppl. 1). — Р. 13-18.

Ernst M.E., Moser M. Use of diuretics in patients with hypertension // N. Engl. J. Med. — 2009. — 361(22). — Р. 2153-2164.

European Society of Hypertension-European Society of Cardiology Guideline Committee. 2003 European Society of Hypertension — European Society of Cardiology Guidelines for the management of arterial hypertension // J. Hypertens. — 2003. — 21(6). — Р. 1011-1053.

Feng W., Dell’Italia L.J., Sanders P.W. Novel paradigms of salt and hypertension // J. Am. Soc. Nephrol. — 2017. — 28(5). — Р. 1362-1369.

Gaddam K.K., Nishizaka M.K., Pratt-Ubunama M.N. et al. Characterization of resistant hypertension: association between resistant hypertension, aldosterone, and persistent intravascular volume expansion // Arch. Intern. Med. — 2008. — 168(11). — Р. 1159-1164.

Garg J.P., Elliott W.J., Folker A., Izhar M., Black H.R. Resistant hypertension revisited: a comparison of two university-based cohorts // Am. J. Hypertens. — 2005. — 18(5 Pt 1). — Р. 619-626.

Gerritsen J., Dekker J.M., TenVoorde B.J. et al. Impaired autonomic function is associated with increased mortality, especially in subjects with diabetes, hypertension, or a history of cardiovascular disease: the Hoorn study // Diabetes Care. — 2001. — 24(10). — Р. 1793-1798.

Gifford R.W. Jr, Tarazi R.C. Resistant hypertension: diagnosis and management // Ann. Intern. Med. — 1978. — 88(5). — Р. 661-665.

Hall J.E., do Carmo J.M., da Silva A.A., Wang Z., Hall M.E. Obesity-induced hypertension: interaction of neurohumoral and renal mechanisms // Circ. Res. — 2015. — 116(6). — Р. 991-1006.

Hermida R.C., Ayala D.E., Smolensky M.H., Fernandez J.R., Mojon A., Portaluppi F. Chronotherapy with conventional blood pressure medications improves management of hypertension and reduces cardiovascular and stroke risks // Hypertens Res. — 2016. — 39(5). — Р. 277-292.

Holmqvist L., Boström K.B., Kahan T., Schiöler L., Qvarnström M., Wettermark B., Hjerpe P., Hasselström J., Manhem K. Drug adherence in treatment resistant and in controlled hypertension-Results from the Swedish Primary Care Cardiovascular Database (SPCCD) // Pharmacoepidemiol. Drug. Saf. — 2018, Jan 19. doi: 10.1002/pds.4388.

Humphrey J.D., Harrison D.G., Figueroa C.A., Lacolley P., Laurent S. Central artery stiffness in hypertension and aging: a problem with cause and consequence // Circ. Res. — 2016. — 118(3). — Р. 379-381.

Hwang A.Y., Dave C., Smith S.M. Trends in antihypertensive medication use among US patients with resistant hypertension, 2008 to 2014 // Hypertension. — 2016. — 68(6). — Р. 1349-1354.

Irvin M.R., Booth J.N. 3rd, Shimbo D. et al. Apparent treatment- resistant hypertension and risk for stroke, coronary heart disease, and all-cause mortality // J. Am. Soc. Hypertens. — 2014. — 8(6). — Р. 405-413.

James P.A., Oparil S., Carter B.L. et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8) // JAMA. — 2014. — 311(5). — Р. 507-520.

Kumbhani D.J., Steg P.G., Cannon C.P. et al. Resistant hypertension: a frequent and ominous finding among hypertensive patients with atherothrombosis // Eur. Heart J. — 2013. — 34(16). — Р. 1204-1214.

Le Jemtel T.H., Richardson W., Samson R., Jaiswal A., Oparil S. Pathophysiology and potential non-pharmacologic treatments of obesity or kidney disease associated refractory hypertension // Curr. Hypertens Rep. — 2017. — 19(2). —

Р. 18.

Mills K.T., Bundy J.D., Kelly T.N. et al. Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries // Circulation. — 2016. — 134(6). — Р. 441-450.

Oparil S., Schmieder R.E. New approaches in the treatment of hypertension // Circ. Res. — 2015. — 116(6). — Р. 1074-1095.

Pimenta E., Gaddam K.K., Oparil S. et al. Effects of dietary sodium reduction on blood pressure in subjects with resistant hypertension: results from a randomized trial // Hypertension. — 2009. — 54(3). — Р. 475-481.

Rimoldi S.F., Messerli F.H., Bangalore S., Scherrer U. Resistant hypertension: what the cardiologist needs to know // Eur. Heart J. — 2015. — 36(40). — Р. 2686-2695.

Rimoldi S.F., Scherrer U., Messerli F.H. Secondary arterial hypertension: when, who, and how to screen? // Eur. Heart J. — 2014. — 35(19). — Р. 1245-1254.

Roush G.C., Holford T.R., Guddati A.K. Chlorthalidone compared with hydrochlorothiazide in reducing cardiovascular events: systematic review and network meta-analyses // Hypertension. — 2012. — 59(6). — Р. 1110-1117.

Salles G.F., Ribeiro F.M., Guimaraes G.M., Mux-feldt E.S., Cardoso C.R. A reduced heart rate variability is independently associated with a blunted nocturnal blood pressure fall in patients with resistant hypertension // J. Hypertens. — 2014. — 32(3). — Р. 644-651. This cross-sectional study found potential association of SNS activity with a blunted nocturnal BP fall in resistant hypertension.

Sarafidis P.A., Georgianos P., Bakris G.L. Resistant hypertension — its identification and epidemiology // Nat. Rev. Nephrol. — 2013. — 9(1). — Р. 51-58.

Sever P.S., Messerli F.H. Hypertension management 2011: optimal combination therapy // Eur. Heart J. — 2011. — 32(20). — Р. 2499-2506.

Sharman J.E., Boutouyrie P., Laurent S. Arterial (aortic) stiffness in patients with resistant hypertension: from assessment to treatment // Curr. Hypertens Rep. — 2017. — 19(1). — Р. 2.

Siddiqui M., Dudenbostel T., Calhoun D.A. Resistant and refractory hypertension: antihypertensive treatment resistance vs treatment failure // Can. J. Cardiol. — 2016. — 32(5). — Р. 603-606.

Smith S.M., Gong Y., Handberg E. et al. Predictors and outcomes of resistant hypertension among patients with coronary artery disease and hypertension // J. Hypertens. — 2014. — 32(3). — Р. 635-643.

Taler S.J., Textor S.C., Augustine J.E. Resistant hypertension: comparing hemodynamic management to specialist care // Hypertension. — 2002. — 39(5). — Р. 982-988.

Vlase H.L., Panagopoulos G., Michelis M.F. Effectiveness of furosemide in uncontrolled hypertension in the elderly: role of renin profiling // Am. J. Hypertens. — 2003. — 16(3). — Р. 187-193.

Weber M.A., Schiffrin E.L., White W.B. et al. Clinical practice guidelines for the management of hypertension in the community: a statement by the American Society of Hypertension and the International Society of Hypertension // J. Clin. Hypertens (Greenwich). — 2014. — 16(1). — Р. 14-26.

Williams B., MacDonald T.M., Morant S. et al. Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): a randomised, double-blind, crossover trial // Lancet. — 2015. — 386(10008). — Р. 2059-2068.

Xiong S., Li Q., Liu D., Zhu Z. Gastrointestinal tract: a promising target for the management of hypertension // Curr. Hypertens Rep. — 2017. — 19(4). — Р. 31.

Zygmuntowicz M., Owczarek A., Elibol A., Olszanecka-Glinianowicz M., Chudek J. Blood pressure for optimal health- related quality of life in hypertensive patients // J. Hypertens. — 2013. — 31(4). — Р. 830-839.

Yook Chin Chia, Siew Mooi Ching. Prevalence and predictors of resistant hypertension in a primary care setting: a cross-sectional study // Chia and Ching BMC Family Practice. — 2014. — 15. — Р. 131. — http://www.biomedcentral.com/1471-2296/15/131




DOI: https://doi.org/10.22141/2224-1485.1.57.2018.125498

Refbacks

  • There are currently no refbacks.


Copyright (c) 2018 HYPERTENSION

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

 

© Publishing House Zaslavsky, 1997-2018

 

   Seo анализ сайта