POOR ACHIEVEMENT OF THE TARGET BLOOD PRESSURE LEVELS ASSOCIATED WITH DIASTOLIC HEART FAILURE IN PATIENTS WITH RESISTANT HYPERTENSION

Abstract

Objective: Aim of this study was to assess the impact of not achievement of the target blood pressure levels on the presence of the diastolic heart failure in patient with resistant hypertension (RH). Design and method: The study included patients with arterial hypertension who received 3 and more AH drugs and had BP > 140/90 mm Hg and were admitted to the department of secondary hypertension. In all patients we performed the following examinations: anthropometry, office blood pressure, electrocardiography (ECG), echocardiography, ABPM, sleep apnea determination, blood biochemical analysis, determination of levels of TTH, T3, T4, blood renin, blood aldosterone levels, blood cortisol level and metanephrine in the urine. Results: The study included 1146 patients with RH who received 3 or more antihypertensive drugs with the level of office blood pressure at admission > = 140/90 mm Hg. The mean age was 57,9 ± 0,37 years. The average body weight is 87,7 ± 0,61 kg, body mass index - 31,0 ± 0,19 kg/m2. Baseline office SBP/DBP - 174,6 ± 0,64/100,5 ± 0,38 mmHg. Half of the patients (51.4%) received 3 antihypertensive drugs, four drugs - 37.1%, five drugs - 9.1%, and six drugs - 2.4% respectively. Our data showed that after correction of the therapy only 31% of patients who received 3 or more antihypertensive drugs had true resistant hypertension. Fixed combinations were taken by 71.9% of patients. Patients who did not achieve target BP had significantly higher cortisol level (155.0 ± 44.0 vs 35.9 ± 20.8 ng/l) and the highest left ventricular mass index (147.5 ± 3.46 vs 135.3 ± 1.74 g/m2), obesity (42.9 vs 37.5 %), kidney function abnormalities (2.7 vs 0.8 %), and also we noted the higher prevalence of the diastolic heart failure in comparison with patients who achieved target BP (16.9 vs 8.5 %). Conclusions: Not achievement of the target blood pressure levels was associated with the presence of the diastolic heart failure in patients with resistant hypertension