Prevalence and Clinical Characteristics of Refractory Hypertension
BackgroundWe aimed to estimate the prevalence of refractory hypertension (RfH) and to determine the clinical differences between these patients and resistant hypertensives (RH). Secondly, we assessed the prevalence of white‐coat RfH and clinical differences between true‐ and white‐coat RfH patients....
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2017-12-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.117.007365 |
| _version_ | 1811332296244985856 |
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| author | Pedro Armario David A. Calhoun Anna Oliveras Pedro Blanch Ernest Vinyoles Jose R. Banegas Manuel Gorostidi Julián Segura Luis M. Ruilope Tanja Dudenbostel Alejandro de la Sierra |
| author_facet | Pedro Armario David A. Calhoun Anna Oliveras Pedro Blanch Ernest Vinyoles Jose R. Banegas Manuel Gorostidi Julián Segura Luis M. Ruilope Tanja Dudenbostel Alejandro de la Sierra |
| author_sort | Pedro Armario |
| collection | DOAJ |
| description | BackgroundWe aimed to estimate the prevalence of refractory hypertension (RfH) and to determine the clinical differences between these patients and resistant hypertensives (RH). Secondly, we assessed the prevalence of white‐coat RfH and clinical differences between true‐ and white‐coat RfH patients. Methods and ResultsThe present analysis was conducted on the Spanish Ambulatory Blood Pressure Monitoring Registry database containing 70 997 treated hypertensive patients. RH and RfH were defined by the presence of elevated office blood pressure (≥140 and/or 90 mm Hg) in patients treated with at least 3 (RH) and 5 (RfH) antihypertensive drugs. White‐coat RfH was defined by RfH with normal (<130/80 mm Hg) 24‐hour blood pressure. A total of 11.972 (16.9%) patients fulfilled the standard criteria of RH, and 955 (1.4%) were considered as having RfH. Compared with RH patients, those with RfH were younger, more frequently male, and after adjusting for age and sex, had increased prevalence of target organ damage, and previous cardiovascular disease. The prevalence of white coat RfH was lower than white‐coat RH (26.7% versus 37.1%, P<0.001). White‐coat RfH, in comparison with those with true RfH, showed a lower prevalence of both left ventricular hypertrophy (22% versus 29.7%; P=0.018) and microalbuminuria (28.3% versus 42.9%; P=0.047). ConclusionsThe prevalence of RfH was low and these patients had a greater cardiovascular risk profile compared with RH. One out of 4 patients with RfH have normal 24‐hour blood pressure and less target organ damage, thus indicating the important role of ambulatory blood pressure monitoring in guiding antihypertensive therapy in difficult‐to‐treat patients. |
| first_indexed | 2024-04-13T16:34:40Z |
| format | Article |
| id | doaj.art-de38107ede09461e95d9ac0ffdcfd818 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T16:34:40Z |
| publishDate | 2017-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-de38107ede09461e95d9ac0ffdcfd8182022-12-22T02:39:29ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802017-12-0161210.1161/JAHA.117.007365Prevalence and Clinical Characteristics of Refractory HypertensionPedro Armario0David A. Calhoun1Anna Oliveras2Pedro Blanch3Ernest Vinyoles4Jose R. Banegas5Manuel Gorostidi6Julián Segura7Luis M. Ruilope8Tanja Dudenbostel9Alejandro de la Sierra10Cardiovascular Risk Area, Internal Medicine Department, Hospital Moisès Broggi Sant Joan Despi, University of Barcelona, SpainVascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, ALHypertension Unit, Nephrology Department, Hospital Universitari del Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, SpainDepartment of Cardiology, Hospital Moisès Broggi Sant Joan Despi, University of Barcelona, SpainDepartment of Medicine, La Mina Primary Care Center, University of Barcelona, SpainDepartment of Preventive Medicine and Public Health, Universidad Autónoma Madrid/IdiPAZ and CIBERESP, Madrid, SpainDepartment of Nephrology, Hospital Universitario Central de Asturias, RedinRen Oviedo, SpainHypertension Unit, Hospital Doce de Octubre, Madrid, SpainInstituto de Investigación Hospital Doce de Octubre, Madrid, SpainVascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, ALInternal Medicine Department, Hospital Mutua Terrassa, University of Barcelona, SpainBackgroundWe aimed to estimate the prevalence of refractory hypertension (RfH) and to determine the clinical differences between these patients and resistant hypertensives (RH). Secondly, we assessed the prevalence of white‐coat RfH and clinical differences between true‐ and white‐coat RfH patients. Methods and ResultsThe present analysis was conducted on the Spanish Ambulatory Blood Pressure Monitoring Registry database containing 70 997 treated hypertensive patients. RH and RfH were defined by the presence of elevated office blood pressure (≥140 and/or 90 mm Hg) in patients treated with at least 3 (RH) and 5 (RfH) antihypertensive drugs. White‐coat RfH was defined by RfH with normal (<130/80 mm Hg) 24‐hour blood pressure. A total of 11.972 (16.9%) patients fulfilled the standard criteria of RH, and 955 (1.4%) were considered as having RfH. Compared with RH patients, those with RfH were younger, more frequently male, and after adjusting for age and sex, had increased prevalence of target organ damage, and previous cardiovascular disease. The prevalence of white coat RfH was lower than white‐coat RH (26.7% versus 37.1%, P<0.001). White‐coat RfH, in comparison with those with true RfH, showed a lower prevalence of both left ventricular hypertrophy (22% versus 29.7%; P=0.018) and microalbuminuria (28.3% versus 42.9%; P=0.047). ConclusionsThe prevalence of RfH was low and these patients had a greater cardiovascular risk profile compared with RH. One out of 4 patients with RfH have normal 24‐hour blood pressure and less target organ damage, thus indicating the important role of ambulatory blood pressure monitoring in guiding antihypertensive therapy in difficult‐to‐treat patients.https://www.ahajournals.org/doi/10.1161/JAHA.117.007365refractory hypertensionresistant hypertensiontarget organ damagewhite coat refractory hypertension |
| spellingShingle | Pedro Armario David A. Calhoun Anna Oliveras Pedro Blanch Ernest Vinyoles Jose R. Banegas Manuel Gorostidi Julián Segura Luis M. Ruilope Tanja Dudenbostel Alejandro de la Sierra Prevalence and Clinical Characteristics of Refractory Hypertension Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease refractory hypertension resistant hypertension target organ damage white coat refractory hypertension |
| title | Prevalence and Clinical Characteristics of Refractory Hypertension |
| title_full | Prevalence and Clinical Characteristics of Refractory Hypertension |
| title_fullStr | Prevalence and Clinical Characteristics of Refractory Hypertension |
| title_full_unstemmed | Prevalence and Clinical Characteristics of Refractory Hypertension |
| title_short | Prevalence and Clinical Characteristics of Refractory Hypertension |
| title_sort | prevalence and clinical characteristics of refractory hypertension |
| topic | refractory hypertension resistant hypertension target organ damage white coat refractory hypertension |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.117.007365 |
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