IS IT RESISTANT HYPERTENSION?

Abstract

Objective: Characterization of patients referred by their general practice physician to our hypertension (HTN) clinic with the diagnosis of resistant HTN. Design and method: Retrospective study of patients with the diagnosis of resistant HTN referred to the HTN clinic from primary care between 2012 and 2017. Data was obtained from electronic medical records and analyzed with SPSS software. Results: From a total of 213 patients presently followed in our HTN clinic, 37 were referred due to resistant HTN. Female sex was slightly more prevalent (51,4%) and the average age was 64 years (with a minimum of 18 and a maximum of 84 years). Patients had a mean duration of HTN of 20 years (ranging from 2 months to 50 years). At the time of referral 41% had grade 1, 27% grade 2 and 22% grade 3 HTN. Other contributing factors to global vascular risk were sedentary lifestyle (68%), excess weight (68%), dyslipidemia (46%), diabetes (38%) and past or current smoking habits (32%). With regard to therapy only 43.2% could formally be deemed resistant HTN according to the current definition (high blood pressure values despite treatment with a diuretic and two other antihypertensive drugs of different classes at adequate dose) and 8% had no diuretic in their prescription. The most prescribed class was angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (67%) followed by diuretics (49%), calcium channel antagonists (43%) and beta-blockers (27%). There was a strong suspicion of noncompliance to the prescribed regimen in 11% of patients. Secondary causes of HTN were found in 24,3% of cases: hyperaldosteronism in 4 patients, hyperthyroidism in 1 and sleep apnea in 4. Conclusions: Defining resistant hypertension remains a clinical problem and an update on its definition should be considered. Patients’ education is of foremost importance in promoting compliance to prescribed therapy and reducing concomitant risk factors. Regarding therapy, clinical inertia should be avoided, promoting optimization of anti-hypertension drugs dosages and implementing diuretics as third class, when indicated, in the primary care setting.