Abstract
BackgroundResistant hypertension (RH) may be one of the cause of the plateau in improving the control rate in hypertension (HT) management. The misdiagnosis of RH by clinic blood pressure (BP) is important clinical problem. Aim of the study were to investigate the prevalence of RH by ambulatory blood pressure monitoring (ABPM) and the factor associated with control status of ambulatory BPs.MethodsFor 1230 subjects taking one or more antihypertensive medication (AHM) enrolled in the Korean Ambulatory Blood Pressure Monitoring (Kor-ABP) registry, the prevalence of RH was calculated which was defined as uncontrolled BP by three AHM classes including diuretic or BP in need of four or more AHM classes. The prevalence determined by clinic versus ambulatory BP was compared.ResultsThe age was 59.3 ± 12.5 years, and 44.3 % were female (n = 1230). Among them 72 subjects were taking three AHM drugs including diuretics and 105 subjects were taking four or more AHM classes. With uncontrolled daytime ambulatory BP in 41 among 72 subjects, prevalence of RH was 11.9 % (146/1230). By using nighttime BP criteria, there was significant difference in the prevalence of RH for clinic versus nighttime BP (146/177 vs. 159/177, p = 0.0124). For control status of daytime BP, masked uncontrolled BP was 16.9 % and controlled BP with white-coat effect was 14.1 %. For nighttime BP control status, odd ratios for smoking (0.624), drinking (1.512), coronary artery disease (0.604), calcium antagonist (1.705), and loop diuretics (0.454) were all significant.ConclusionThe prevalence itself was 11.9 % by daytime BP and it was significantly higher when using nighttime BP criteria. Control status of daytime BP was misclassified in 31.0 %. Smoking, drinking, coronary artery disease, calcium antagonist, and loop diuretics were associated with nighttime BP control status.
Highlights
Resistant hypertension (RH) may be one of the cause of the plateau in improving the control rate in hypertension (HT) management
Resistant hypertension (RH) is defined as the hypertension (HT) which cannot be controlled below the target blood pressure even if treated with three or more antihypertensive medications (AHM) classes one of which was diuretics or HT which requires four or more AHM classes regardless whether the blood pressure was controlled or not [1]
Subjects Among 3766 subjects who were enrolled for Korean Ambulatory Blood Pressure Monitoring (Kor-ABP) registry during the period from 1st August, 2009 to the end of 2012, 1242 subjects with relevant clinical information and who were treated with at least one AHM were selected for the study
Summary
Resistant hypertension (RH) may be one of the cause of the plateau in improving the control rate in hypertension (HT) management. The trend in the control rate of HT in the treated patient has reach a plateau just below 70 % in Korean population [2]. Because the control of HT is essential component in preventing cardiovascular events, the obstacle against improving the control rate of HT is a very important clinical issue and the epidemiologic study is very important to provide a basis for setting up management strategy of RH. As shown in the recent clinical trial, the learning from the misdiagnosis of RH using only clinic BP made out-ofoffice BP measurement, preferably ABPM, as the essential component of the evaluation before adopting the new therapeutic modality [3]. As long as the accurate diagnosis of RH using ABPM is concerned, there are few reports regarding the demographic or clinical factors related to the RH
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