Abstract P118: Metabolic And Hemodynamic Disorders In Obese Patients With True And Pseudo-resistant Hypertension

Abstract

Objective: to conduct a comparative assessment between pseudo-resistant and true resistant hypertension (RH) in obesity. Methods: The study included 302 patients with uncontrolled hypertension and obesity. Initial treatment efficacy was assessed 3 months after dual therapy was administered. Those patients who did not reach target blood pressure (BP) in dual therapy were transferred to triple therapy. Among patients who received triple therapy, 69 people did not reach target BP (they received the fourth drug spironolactone). All patients were additionally examined 6 months after the initiation of antihypertensive therapy. Results: In the absence of a difference in BP levels, patients who subsequently become resistant, already at the stage of inclusion, significantly more often had circadian rhythm (CR) violations with a predominance of the non-dipper CR. Despite the target BP achievement after 6 months, in the majority (91.42%) of non-RH patients, the CR normalized, while in RH a normal CR was only in 60.87%. At the stage of enrolling patients into the study and 3 months after the start of therapy there was no significant difference in BP levels between true and pseudo-RH, then after 6 months of therapy, patients with true RH had significantly higher office SBP levels (p<0.01) and 24 h average SBP according to ABPM data (p<0.05) compared with pseudo-RH. Already at the stage of inclusion in the study, the normal CR in true RH was significantly less common than in pseudo-RH, and during the prescribed therapy, a similar trend persisted: after 6 months of therapy, 71.05% of pseudo-RH had a normal CR, while with true RH - only about half of the patients. Obese patients with true RH had also significantly lower BMI and LDL-cholesterol (p<0.05) as well as higher levels of aldosterone and SBP (p<0.05) compared with pseudo-RH. Conclusions: Even when target BP levels in antihypertensive therapy are achieved, obese patients with RH are characterized by more pronounced CR disturbances and higher levels of office and out-of-office BP, compared with non-RH. Compared with pseudo-RH, the presence of true RH in obesity is associated with higher SBP and aldosteron levels, as well as lower BMI and LDL-cholesterol.