Prevalence of resistant hypertension in uncontrolled hypertensive patients seen in consultation

Abstract

Resistant hypertension is defined by hypertension not controlled in consultation and confirmed by measurement outside the doctor's office, despite a therapeutic strategy comprising adapted hygiene and dietetic rules and antihypertensive triple therapy for at least 4 weeks, at optimal dose, including a thiazide diuretic. Screening for resistant hypertension in internal medicine and cardiology consultation. Prospective study including 1862 hypertensive patients, aged 18 and over, treated for at least one year and referred for uncontrolled hypertension, seen between October 2015–December 2019. The verification of the non-achievement of the blood pressure target was performed in all patients, either by ambulatory blood pressure measurement (ABPM) or by AMT (self-measurement of blood pressure), and revealed a blood pressure target not reached each time. Of the 1862 patients screened, mean age 58 ± 13.4 years, including 838 men (45%), and 1024 women (55%), 896 (48%) were receiving non-optimal treatment, 45% of patients had a BMI greater than 30 kg/m 2 (41% men vs. 59% women), 23% were smokers, and 45% were diabetics. In total, 612 (32.8%) were poor observers and 202 (8.5%). A secondary cause of hypertension was identified in 175 (9.4%) patients. Finally, only 112 patients presented with hypertension requiring quadruple therapy or more, either a prevalence of 6.01% (95% CI: 5.6–7.2). It should be noted that three of our patients benefited from renal denervation practiced in our department, the immediate responses were satisfactory. Less than 15% of the patients referred to our consultation present a true hypertension, and almost half present a pseudo-resistance. The majority of patients with apparently resistant hypertension can achieve the blood pressure goal if they are sensitized, observant, and properly treated.