HIGH PREVALENCE OF INFLAMMATORY DISORDERS IN PATIENTS WITH REFRACTORY HYPERTENSION

Abstract

Objective: Refractory hypertension (RfHTN) is a phenotype of antihypertensive treatment failure defined as uncontrolled BP (> = 135/85 mmHg) despite the use of five or more different antihypertensive agents, including a long-acting thiazide-like diuretic (chlorthalidone) and a mineralocorticoid receptor antagonist (spironolactone or eplerenone). Experimental and clinical studies link the development of hypertension to inflammation and various inflammatory disorders play an important role in development of hypertension. The prevalence of inflammatory disorders such as systemic lupus erythematosus (SLE) and sarcoidosis in patients with RfHTN has not been previously determined. Design and method: In this prospective evaluation, 40 patients with confirmed RfHTN were recruited from the Hypertension Clinic after having uncontrolled BP at three or more clinic visits. All patients were evaluated by automated office BP (AOBP) with the BpTRU device, ambulatory BP monitoring (ABPM), and by 24-hr urine collection to detect antihypertensive medication adherence by high-performance liquid chromatography-tandem mass spectrometry. Out of 36 patients who underwent ABPM monitoring, 32 patients had RfHTN as confirmed by AOBP and by ABPM. Of these, 9 patients were fully adherent on medications. Twenty-five patients with controlled resistant hypertension (RHTN) by AOBP, ABPM with total medication adherence served as the comparative group. Results: 56% of patients with RfHTN had sarcoidosis and/or SLE. In comparison, the prevalence of the two disorders in patients with controlled RHTN was only 16% (p = 0.034). In addition, C-reactive protein was significantly higher in rfhtn compared to controlled RHTN (19.8 ± 3.2 vs 3.2 ± 1.2 mg/L; p = 0.042). Conclusions: Patients with confirmed RfHTN have a higher prevalence sarcoidosis and/or SLE compared to non-refractory controls, suggesting a possible role autoimmune or inflammatory disorders in the development of RfHTN.