Abstract 2457: Predictors of Resistant Hypertension in an Eight Year Follow-Up Study of an Unselected Sample of Adult Male Population in Italy

Abstract

Background: The determinants of resistant hypertension (RH), defined as a blood pressure (BP) persistently above goal in spite of the concurrent use of 3 antihypertensive agents of different classes, remain largely unknown. We investigated the predictors of RH in 799 participants at the Olivetti Heart Study (OHS), mean age 51.5 yrs (SD±7.2) after an average follow-up period of 8 yrs. Methods: All participants attending the basal (1994 –95) and final (2002– 04) examination of the Olivetti Heart Study. A complete database including anthropometric, biochemical and ECG data was available for the analysis. Results: Among the 799 participants not affected by RH at basal examination, 497 (62.2%) were normotensive and 302 (37.8%) hypertensive. After 8 years, overall 29 subjects (3.6%) developed RH. Age, BMI, waist circumference, BP, Cornell Index, serum total cholesterol and uric acid, urinary fractional sodium excretion (FENa), a marker of dietary sodium intake, and albuminuria (ALB) were significantly higher (p<0.05) in participants who developed RH compared with the others. Using a logistic regression model, after adjustment for basal antihypertensive treatment, microalbuminuria (Odds Ratio; C.I 95%: 3.2;1.1– 9.3), proteinuria (12.2; 1.9 –76.5), systolic BP (2.1;1.4 –3.3) and FENA (1.4; 1.1–1.7) remained the only independent predictors of RH. Conclusions: Our results indicate that an early marker of organ damage (albuminuria), an elevated dietary sodium intake and a higher basal BP level were independent predictors of the development of RH in this sample of adult male population.