PP.10.09] PREVALENCE OF TRUE RESISTANT HYPERTENSION IN UNCOMPLICATED HYPERTENSIVES WITH APPARENT TREATMENT-RESISTANT HYPERTENSION IN LONGITUDINAL REAL-LIFE STUDY

Abstract

Objective: Our aim was to compare target office (<140/90mmHg) and home (<135/85 mmHg) blood pressure (BP) attainment after 6-month (6 M) of standardized algorithmic treatment in uncomplicated hypertensives (UH), with clinical BP previously uncontrolled on 3 or more antihypertensive medications, ie with apparent treatment-resistant hypertension (aTRH). Design and method: 54 Kiev city cardiologists recruited in PERFECT-BP prospective observational study (ISRCTN75706523) 407 treated but uncontrolled UH (BP < 200/120 mmHg), aged 59,3 ± 8,9 years, 42,3% male. At visit 1 patients (pts) were prescribed or switched to a fixed-dose combination (FDC) of perindopril/amlodipine (doses at discretion of MDs), which was followed by FDC uptitration, and, if needed, by consecutive addition of indapamide SR, spironolactone, and moxonidine or doxazosin. Office BP measurements were performed with standardized automatic device Microlife BPW200 with universal cuff. Home BP measurements were performed with validated oscillometric device Microlife BP3AG1 with individually selected cuff, twice pd for 7 consecutive days before each visit at day 7, M1, 2, 3, 6. After 6 M treatment pts compliance was assessed by X. Gererd questionnaire. Results: Baseline therapy of 122(30%) pts included 3 or more drugs (aTRH group) with optimal treatment regimens in 28(23%) of them. By 6 M office systolic BP in aTRH pts decreased from 166,1 ± 14,6 to 132,8 ± 9,4 mmHg, diastolic BP – from 97,7 ± 10 to 79,3 ± 7,3mmHg. At 6 M 63% of pts with aTRH attained target office BP by triple therapy, 11,1% – by 4 or more drugs, with masked hypertension in 21,3% of them. Target office and home BP despite of 3 or more drugs, prescribed in optimal doses, were not attained in 10,2% of aTRH pts with high or moderate adherence. Low adherence was the reason for lack of office BP control in 4,6% of pts, physician[Combining Acute Accent]s inertia (only 2 drugs were prescribed) – in 7,4%. White coat hypertension was identified in 3,7% of aTRH pts. Conclusions: Target office BP after 6 M of standardized algorithmic treatment based on FDC in real life setting was attained in 74,1% of UN with baseline aTRH, with 10,2% prevalence of true resistant hypertension.