PP.23.17

Abstract

Objective: Essential hypertension is associated with bioumoral abnormalities that might be related to poor hypertension control. Identification of these abnormalities might be useful in tailoring antihypertensive treatment, in order to reach blood pressure targets. Design and method: We examined 600 patients with essential hypertension diagnosed for more than 4 years. We initiated or adjusted antihypertensive treatment at first visit and evaluated response to treatment at 1 month. In patients not reaching blood pressure target, we measured plasma levels of aldosterone, cortisol, catecholamines, glucose, uric acid and lipid profile. We recorded the association of obesity, dyslipidemia, type 2 diabetes mellitus, ischemic heart disease and chronic kidney disease. Results: 97 patients (62 males and 35 females), aged 27 to 76 years, were found to be above blood pressure target at the second visit. All these patients had a family history of essential hypertension. 35 patients (36.1%) were obese, 24 (24.7%) had type 2 diabetes mellitus, 30 (30.9%) had ischemic heart disease and 18 (18.6%) had both diabetes mellitus and ischemic heart disease. Kidney function was mildly reduced (eGFR 60 – 89 ml/min/1.73 m2) in 50 patients (51.5%), whereas 3 patients (3.1%) had moderate chronic kidney disease (eGFR 30 – 59 ml/min/1.73 m2) and none had severe chronic kidney disease. Hyperuricemia was encountered in 11 patients (11.3%). High plasma cholesterol levels were found in 49 patients (50.5%). 39 patients (40.2%) had high LDL-C levels, 19 (19.6%) had low HDL-C levels and 34 (35.1%) had high plasma triglycerides. 15 patients (15.5%) had high plasma aldosterone levels, 3 (3.1%) had high basal cortisol and 5 (5.2%) had high plasma noradrenaline. All patients had normal thyroid function. Patients having abnormal plasma levels of aldosterone, cortisol or catecholamines were examined by an endocrinologist and secondary hypertension of endocrine origin was ruled out. Conclusions: Obesity, dyslipidemia, type 2 diabetes mellitus, ischemic heart disease and mild chronic kidney disease are frequently encountered in patients with uncontrolled essential hypertension. Plasma levels of aldosterone, cortisol and catecholamines may be high in these patients in the absence of endocrine disease and might be regarded as potential treatment targets.