CARDIOVASCULAR RISK PROFILE OF REFRACTORY HYPERTENSION DIAGNOSED BY ABPM AND HBPM IN A COHORT OF RESISTANT HYPERTENSION

Abstract

Objective: Refractory hypertension (RefHT) is considered an extreme phenotype of resistant hypertension (RHT) and has recently been defined as uncontrolled blood pressure (BP) despite the use of 5 or more antihypertensives including a long-acting thiazide diuretic and a mineralocorticoid receptor antagonist. The objective of this study is to evaluate the clinical profile and characterize the cardiovascular (CV) risk involved through the analysis of hypertension-mediated organ damage (HMOD) and established cardiovascular disease. Design and method: This is a cross-sectional study of a historical cohort of patients with RHT who underwent a standardized protocol consisting of: a questionnaire to record cardiovascular risk factors (physical inactivity, smoking, obesity, dyslipidemia, and diabetes), hypertension-mediated organ damage (albuminuria, chronic kidney diseases (CKD) stage 3, left ventricular hypertrophy (LVH) diagnosed by transthoracic echodopplercardiogram, and arterial stiffness measured by pulse wave velocity) and established CV diseases (coronary diseases, stroke, heart failure, peripheral arterial disease, and CKD stage 4 or 5). All of them were submitted to 24-hour ABPM and 5-day HBPM (triplicate morning and evening measurements). Results: A total of 354 patients (23.9% male; mean age 60.4 ± 11.1 years old) was included in the study. The prevalence of RefHT was 20.3% (72 patients) by ABPM and 18.9% by HBPM (67 patients). In both groups, refractories were younger with higher levels of albuminuria. Refractory patients diagnosed by the ABPM had a higher prevalence of stroke (18.1% vs 9.6%) and established CV diseases (45.8% vs 33.7%) than resistant patients. We did not observe differences regarding LVH (75.0% vs 71.8%), arterial stiffness (13.1% vs 16.4%) and CKD stage 3 (22.2% vs 27.0%). In turn, refractory patients diagnosed by HBPM had a higher prevalence of heart failure (7.5% vs 2.8%), also showing similar prevalence of LVH (76.1% vs 71.6%), arterial stiffness (12.7% vs 16.4%), and CKD stage 3 (22.4% vs 26.8%). Conclusions: Refractory hypertensives presented a cardiovascular risk profile similar to resistant hypertensives, despite the lack of blood pressure control. Possibly the pharmacological treatment with spironolactone acting on the neurohumoral axis of hypertension may have an impact on the clinical course and survival of these patients.