Abstract
Background: The presence of elevated blood pressure (BP) despite the use of at least three different medications, including a diuretic, is defined resistant hypertension (RH). RH is associated with high risk of stroke, myocardial infarction and arrhythmia. Detection of high risk phenotypes for RH could be of great help in better addressing and graduating initial therapy. Thus, predictors of RH were identified in a large population of hypertensive patients. Methods: We studied 6,215 hypertensive patients (age 53±11 years, 57% men, systolic BP [SBP]: 158±20, diastolic BP [DBP]: 99±10) without prevalent cardiovascular disease and with MDRD-estimated glomerular filtrate ratio (eGFR)>30 mL/mmHg/1.73 m2. Results: After a mean follow up time of 61±43 months, 12% of the studied population was classified as RH (n=744). Patients with RH were older (57±10 vs 52±11, p<0.0001), and more often women (p<0.0001). At baseline, patients with follow-up RH were more often diabetics (11% vs 4%), more often had metabolic syndrome (MetS, 23% vs 14%; both p<0.0001), and exhibited higher values of SBP, DBP, BMI, fasting triglycerydes and glucose, LV mass, carotid intima-media thickness (IMT), duration of hypertensive disease, pulse pressure/stroke index (PP/SVi), relative wall thickness and lower values of eGFR and serum potassium (all p<0.001). In a Cox model including the variables that were different in the descriptive analysis, follow up RH was independently predicted by: female sex (p=0.015; HR=1.22; CI=1.04-1.42), older age (p<0.0001; HR=1.03/year: CI=1.02-1.04), higher LV mass index (p=0.001; HR=1.02/g*m-2.7; CI=1.02-1.03) and SBP (p<0.0001; HR=1.05/x 5 mmHg; CI 1.01-1.10), longer duration of hypertension (p<0.0001; HR=1.02/year; CI 1.01-1.03) and MetS (p<0.003; HR=1.36; CI 1.11-1.67), at the initial visit, without a significant impact for diabetes, BMI, smoking habits, DBP, eGFR, serum potassium, fasting triglycerides and glucose, IMT and PP/SVi. Conclusion: In essential hypertensive patients, resistance to maximal antihypertensive therapy is more frequent in women with MetS and is predicted by older age, higher initial values of SBP, longer duration of hypertensive disease and presence of cardiovascular target organ damage.
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