Abstract 074: Use of Antihypertensive Drugs, Drug Classes, and Combinations in Resistant versus Non-resistant Hypertension, and in True versus White-coat Resistant Hypertension

Abstract

We aimed to evaluate the use of specific antihypertensive drugs and drug classes, as well as combinations in patients treated with 3 or more drugs classified as having or not resistant hypertension (RH), controlled or uncontrolled RH and true versus white-coat RH. From the Spanish ABPM Registry, we identified 21238 patients treated with 3 (14264) or more (6974) antihypertensive drugs of different classes. Among patients treated with 3 drugs we compared those with controlled (<140/90 mmHg; No RH) or uncontrolled (RH) office BP. In patients treated with 4 or more drugs we compared controlled versus uncontrolled RH. Moreover in uncontrolled RH patients, we compared those with white-coat (normal ABPM) versus true RH. We evaluated the use of different antihypertensive drug classes, specific antihypertensive drugs inside each class, and types of combinations. Results were adjusted for age, gender, and previous history of cardiovascular disease. With respect to RH treated with 3 drugs, those No RH used more frequently aldosterone antagonists (AA; Relative risk: 1.82; 1.40-2.37. They also used more frequently clorthalidone (CTL) among diuretics (RR: 1.54; 1.24-1.91), amlodipine (AML) among calcium channel blockers (CCB; RR: 1.12; 1.00-1.24) and bisoprolol (BIS) among beta blockers (RR: 1.18; 1.03-1.35). In patients treated with 4 or more drugs, controlled RH was also associated with the use of AA (RR: 1.41; 1.14-1.73) and AML (RR: 1.42; 1.25-1.62). No differences were observed in the type of combination used. When comparing patients with true versus white-coat RH, the latter group used more frequently diuretics (RR: 1.31; 1.16-1.47), CTL (RR: 1.79; 1.48-2.16) among diuretics, and AML (RR: 1.44; 1.32-1.57) among CCB. The triple combination of RAS blockers, CCB, and diuretics was also more frequently used in those with white-coat RH (RR: 1.09; 1.00-1.19). In conclusion, controlled office BP among patients treated with 3 or more drugs is associated with AA, CTL, and AML use. White-coat RH is associated with more diuretic use, especially CTL, AML, and the combination of RAS blockers, CCB, and diuretics. These results support the use of such triple combination, preferably including CTL and AML, and the addition of AA in order to reduce the prevalence of RH and true RH.