PP.26.28

Abstract

Objective: Treatment resistant hypertension is a challenge for the physician and represents a substantial cardiovascular risk for patients. While many patients are referred to specialists for resistant hypertension, the true resistant subjects are hard to find. We aimed to report the reasons for noneligibility in the Oslo Renal Denervation (RDN)Study following directly observed therapy (DOT) of antihypertensive drugs prior to ambulatory blood pressure monitoring (ABPM). Design and method: Patients with apparent resistant hypertension (n = 83), supposed to fulfill the inclusion/exclusion criteria, which were similar, but not identical with the SYMPLICITY HTN-2 criteria, were referred for renal denervation. All patients went through a throrough clinical and laboratory work-up including screening for renovascular hypertension, renal disease, primary hyperaldosteronism, Cushing's syndrome and pheochromocytoma. Nonadherence to antihypertensive drugs and white coat hypertension were controlled for by directly observed therapy followed by ABPM. Results: The proportion of patients being noneligible for renal denervation according to our inclusion/exclusion criteria was 69.9 %. The main reasons for noneligibility were normalization of blood pressure following witnessed intake of antihypertensive drugs (DOT) (43.0 %). Those with high office blood pressure in our clinic, but without prior ABPM from their referring physician, who had normal ABPM after DOT, were labeled white coat hypertensives. However, the possibility of nonadherence even among these subjects cannot be ruled out.Conclusions: True treatment resistant hypertension is rare. Secondary and spurious hypertension can be revealed and treated when medical evaluation of the patients is done thoroughly and according to guidelines by hypertension specialists. Nonadherence seems to be the most common reason for uncontrolled hypertension and may be revealed by directly observed therapy (DOT) followed by ambulatory blood pressure.