Prevalence and Clinical Characteristics of Refractory Hypertension
Armario, Pedro (Universitat de Barcelona)
Calhoun, David A. (University of Alabama at Birmingham)
Oliveras i Serrano, Anna (Institut Hospital del Mar d'Investigacions Mèdiques)
Blanch, Pedro (Universitat de Barcelona)
Vinyoles, Ernest (Universitat de Barcelona)
Banegas Banegas, José Ramón (Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública)
Gorostidi, Manuel (Hospital Universitario Central de Asturias)
Segura, Julián (Hospital Universitario 12 de Octubre (Madrid))
Ruilope, Luis M. (Instituto de Investigación Sanitaria Hospital 12 de Octubre (Madrid))
Dudenbostel, Tanja (University of Alabama at Birmingham)
De la Sierra, Alejandro (Universitat de Barcelona)

Fecha:	2017
Resumen:	We aimed to estimate the prevalence of refractory hypertension (RfH) and to determine the clinical differences between these patients and resistant hypertensives (). Secondly, we assessed the prevalence of white-coat RfH and clinical differences between true- and white-coat RfH patients. The present analysis was conducted on the Spanish Ambulatory Blood Pressure Monitoring Registry database containing 70 997 treated hypertensive patients. 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 () 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 , and 955 (1. 4%) were considered as having RfH. Compared with 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 (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). The prevalence of RfH was low and these patients had a greater cardiovascular risk profile compared with . 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.
Nota:	Funding: The Spanish ABPM Registry was initiated and is maintained by an unrestricted grant from Lacer Laboratories, Spain, and receives support by the Spanish Society of Hypertension.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Refractory hypertension ; Resistant hypertension ; Target organ damage ; White coat refractory hypertension ; Hypertension
Publicado en:	Journal of the American Heart Association. Cardiovascular and cerebrovascular disease, Vol. 6 (december 2017) , ISSN 2047-9980

DOI: 10.1161/JAHA.117.007365
PMID: 29217663

7 p, 283.2 KB

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