RESISTANT HYPERTENSION IN PRIMARY CARE
Aim: To evaluate the incidence and clinical features of resistant hypertension in primary care.
Methods: A number of 2340 hypertensive patients, from 8 family medicine offices in Timis County were evaluated during 2010-2013. Resistant hypertension was considered in patients treated with at least 3 antihypertensive agents, including a diuretic, when BP exceeded the target values of 140 and/or 90 mmHg. The database of the patients included demographical and clinical variables as cardiovascular risk factors, target organ damage, cardiovascular events, treatment, office BP measurement and 24-h ABPM.
Results: 467 (19.9%) of the patients did not reach the target BP values after being treated with 3 antihypertensive agents. Of these 374 (80.1%) had pseudo resistant hypertension as following: 116 patients (24.8%) had problems with „white-coat hypertension”, 102 (21.8%) had medication related causes, 45 (9.64%) had excessive dietary sodium and ethanol consumption, 19 (4.1%) had secondary hypertension and 9 (1.9%) had associated psychological causes. The 93 patients with resistant hypertension were old (mean age 66 vs. 56 years), most frequently obese (55% vs. 35%) and diabetics (35% vs. 16%). They presented a higher incidence of target organ damage (34% vs. 16%) and previous cardiovascular events (26% vs. 12%). ABPM 24-hour diurnal and nocturnal values were higher in patients with resistant hypertension, especially regarding nighttime BP. Non-dipper or riser patterns had a higher prevalence in the resistant hypertension group.
Conclusion: It is essential to exclude pseudo resistance resulting from improper BP recording techniques, failure of the patient to adhere to the prescribed treatment regimen or other causes. Patients with resistant hypertension are elders, more frequently obese and diabetics, exhibit more signs of target organ damage and cardiovascular disease, have higher nocturnal BP and more frequently non-dipper or riser patterns of hypertension.