Clinical profile and management approach of patients diagnosed with resistant hypertension in a tertiary government hospital

Abstract

Resistant hypertension is blood pressure that remains above target despite treatment with maximum doses of 3 anti-hypertensive drugs which may include a diuretic. The prevalence of resistant hypertension is unknown, and there are no local studies in the Philippines concerning this condition. A retrospective descriptive study was conducted in the Hypertension Clinic of the Section of Hypertension of the Philippine General Hospital (PGH) to describe the approach of management of patients with resistant hypertension which may eventually help in creating local guidelines in the management of this condition. A total of 51 patients were diagnosed with resistant hypertension, and charts were reviewed and analyzed. Majority of the patients were females (31, 60.8%) with a mean age of 56.3 yrs. Their most common presenting symptoms were headache, exertional dyspnea, nape pain, dizziness and easy fatigability. Of the 51 patients, 45% also had diabetes mellitus, 11.8% had dyslipidemia and 7.8% had previous history of pre-eclampsia. Approximately 35% of these patients were smokers. The average BP before referral to the section was 167/94. By this time, most patients will either be on a 4-drug regimen (42.1%) or a 3-drug regimen (36.8%). Physicians often prescribe a 2-drug combination as their initial management of hypertension (42.1%) with the usual combination of a calcium channel blocker and a beta blocker. Twelve patients were started on monotherapy using a beta-blocker or an ACE-inhibitor. Patients had a median number of 6 follow-ups prior to referral to a hypertension specialist. The median number of visits in the Hypertension Clinic prior to control of BP was 3 follow-ups, and the average BP was 119/71. The regimens of the patients with controlled BP are 3-drug combinations (36.4%), 4-drug combination (36.4%) and 5-drug combination (27.3%). Female gender, older age, diabetes and a BP within the range of stage II hypertension may contribute to the development of resistant hypertension in the Philippine population. Early referral to a hypertension specialist may benefit a patient with resistant hypertension, decreasing the number of follow-up visits to control a patient's blood pressure. Four to five drug combinations may be needed to adequately control a patient's blood pressure.