Refractory Hypertension: Definition, Prevalence, and Patient Characteristics
Open Access
- 15 November 2011
- journal article
- research article
- Published by Wiley in The Journal of Clinical Hypertension
- Vol. 14 (1), 7-12
- https://doi.org/10.1111/j.1751-7176.2011.00556.x
Abstract
J Clin Hypertens (Greenwich). Among patients with resistant hypertension (RHTN), there are those whose blood pressure (BP) remains uncontrolled in spite of maximal medical therapy. This retrospective analysis aims to characterize these patients with refractory hypertension. Refractory hypertension was defined as BP that remained uncontrolled after ≥3 visits to a hypertension clinic within a minimum 6‐month follow‐up period. Of the 304 patients referred for RHTN, 29 (9.5%) remained refractory to treatment. Patients with refractory hypertension and those with controlled RHTN had similar aldosterone levels and plasma renin activity (PRA). Patients with refractory hypertension had higher baseline BP (175±23/97±15 mm Hg vs 158±25/89±15 mm Hg; P=.001/.005) and heart rate, and higher rates of prior stroke and congestive heart failure. During follow‐up, the BP of patients with refractory hypertension remained uncontrolled (168.4±14.8/93.8±17.7 mm Hg) in spite of use of an average of 6 antihypertensive medications, while those of patients with controlled RHTN decreased to 129.3±11.2/77.6±10.8 mm Hg. Spironolactone reduced the BP by 12.9±17.8/6.6±13.7 mm Hg in patients with refractory hypertension and by 24.1±16.7/9.2±12.0 mm Hg in patients with controlled RHTN. In patients with RHTN, approximately 10% remain refractory to treatment. Similar aldosterone and PRA levels and a diminished response to spironolactone suggest that aldosterone excess does not explain the treatment failure.Keywords
This publication has 16 references indexed in Scilit:
- Rapid Reversal of Left Ventricular Hypertrophy and Intracardiac Volume Overload in Patients With Resistant Hypertension and HyperaldosteronismHypertension, 2010
- Effects of Dietary Sodium Reduction on Blood Pressure in Subjects With Resistant HypertensionHypertension, 2009
- Results of a retrospective, observational pilot study using electronic medical records to assess the prevalence and characteristics of patients with resistant hypertension in an ambulatory care settingClinical Therapeutics, 2009
- Low-renin status in therapy-resistant hypertensionJournal of Hypertension, 2004
- Prevalence of primary hyperaldosteronism in moderate to severe hypertension in the Central Europe regionJournal of Human Hypertension, 2003
- Hyperaldosteronism Among Black and White Subjects With Resistant HypertensionHypertension, 2002
- Resistant HypertensionHypertension, 2002
- High prevalence of unrecognized sleep apnoea in drug-resistant hypertensionJournal of Hypertension, 2001
- Screening for primary aldosteronism without discontinuing hypertensive medications: Plasma aldosterone-renin ratioAmerican Journal of Kidney Diseases, 2001
- Management of the Patient With Resistant HypertensionHospital Practice, 1981