DISTURBANCES OF THE CIRCADIAN RHYTHM AND BLOOD PRESSURE LEVELS IN OBESE PATIENTS WITH TRUE AND PSEUDO-RESISTANT HYPERTENSION

Abstract

Objective: The aim was to conduct a comparative assessment of the circadian rhythm abnormalities and blood pressure (BP) levels between pseudo-resistant and true resistant hypertension (RH) in obesity. Design and method: 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 BP in dual therapy were transferred to triple therapy. Among patients who received triple therapy, 69 people did not reach target BP. All patients were additionally examined 6 months after the initiation of antihypertensive therapy. Results: In the absence of a difference in BP, patients who subsequently become resistant, already at the stage of inclusion, significantly more often had a violation of the circadian rhythm with a predominance of the non-dipper rhythm. Despite the achievement of target BP after 6 months of therapy, in the majority (91.42%) of patients without resistance, the circadian rhythm normalized, while resistant patients had a normal circadian rhythm only in 60.87%. At the stage of enrolling patients into the study and 3 months of therapy there was no significant difference in BP between true and pseudo-resistance, then after 6 months of therapy, patients with true resistance had significantly higher office SBP (p < 0.01) and 24 h average SBP according to ABPM data (p < 0.05) compared with pseudo-resistant patients. Already at the stage of inclusion in the study, the normal circadian rhythm in true resistance was significantly less common than in pseudo-resistance; during the prescribed therapy, a similar trend persisted: after 6 months of therapy, 71.05% of pseudo-resistant patients had a normal circadian rhythm, while with true resistance only about half of the patients had a normal circadian rhythm. Conclusions: Even when target BP levels in antihypertensive therapy are achieved, obese patients with RH are characterized by more pronounced disturbances of the circadian rhythm (most often non-dipper) and higher levels of office and out-of-office BP, compared with non-resistant patients. Compared with pseudo-resistant patients, the presence of true resistance in obesity is associated with higher SBP levels and a higher incidence of circadian rhythm disturbances.