PREDICTORS OF EVENTUAL BLOOD PRESSURE CONTROL IN PATIENTS WITH RESISTANT HYPERTENSION AFTER INTENSIVE MANAGEMENT IN TWO EXPERT CENTRES

Abstract

Objective: Management of resistant hypertension (RHTN) is challenging and often implies the use of complex polypharmacy and interventional therapies. The main objectives of this study were (i) to describe the characteristics of patients with RHTN referred to two expert centres; (ii) to identify distinctive features of patients eventually controlled after intensive management in the expert centre compared with those who remained refractory Design and method: We reviewed electronic medical files of all patients referred for RHTN to the Brussels and Turin centres, and extracted detailed clinical data, data on drug adherence and psychological profile. All patients with confirmed diagnosis of RHTN, according to office and ambulatory BP monitoring (ABPM) measurements, were considered eligible. Results: 313 patients (51% men; age: 56 ± 12 years; office BP 177/98 mmHg; 24-hour ABPM 153/90 mmHg) were included. At the end of the follow-up (median: 2 years [1–4]), only 26% of patients (n = 81) reached BP control. When compared to patients remaining resistant, patients eventually controlled had lower pulse pressure (71 vs. 82 mmHg, p < 0.001), less often myocardial infarction (6% vs. 20%, p < 0.005) and showed a higher recourse to cognitive reappraisal as far as emotion regulation is concerned (4.8 ± 1.1 vs. 3.9 ± 1.2, p = 0.009; ERQ Questionnaire). In a multivariate analysis looking for predictors of controlled BP, only the psychological characteristic of cognitive reappraisal (i.e., changing one's thoughts about a potentially emotion-eliciting event) remained significant (OR 1.95 IC 95% [1.11; 3.4], p = 0.019). Conclusions: Even in expert centres, only a minority of patients with RHTN reached BP control, irrespective of the centre involved or the interventions applied. Patients who eventually responded to therapy had lower arterial stiffness and less cardiac organ damage. Furthermore, in agreement with our previous study [Petit G et al. Blood Pressure 2018;27:358–367], besides vascular damage, the single predictor of BP control was the ability to modify the emotional impact of stressful situations.