Prevalencia de lesión de órganos diana y alteraciones metabólicas en la hipertensión arterial refractaria

Abstract

Background and objective Patients with resistant hypertension (RH) are relatively frequently visited in specialized units of hypertension. The aim of this study was to assess the prevalence of target organ damage, central obesity and metabolic syndrome in a cohort of patients with RH consecutively included in the Register of Resistant Hypertension of the Spanish Society of Hypertension (SHE-LELHA). Patients and methods Cross-sectional, multicenter epidemiologic study in usual clinical practice conditions. Patients with clinical diagnosis of resistant hypertension, that is, office systolic and diastolic blood pressure ≥ 140 mmHg and/or ≥ 90 mmHg, respectively, despite a prescribed therapeutic schedule with an appropriate combination of three or more full-dose antihypertensive drugs, including a diuretic, were consecutively recruited from specialized hypertension units spread through Spain. Demographic and anthropometric characteristics as well as cardiovascular risk factors and associated conditions were recorded, and all the subjects underwent 24-h ambulatory blood pressure monitoring. Left ventricular hypertrophy was considered as a left ventricular mass index ≥ 125 g/m 2 in males and ≥ 110 g/m 2 in females. Left atrial enlargement was defined as an indexed left atrium diameter ≥ 26 mm/m 2. Microalbuminuria was defined as a urinary albumin/creatinine ratio ≥ 22 mg/g in males and ≥ 31 mg/g in females. Results 513 patients were included, aged 64 ± 11 years old, 47% women. Central obesity was present in 65.7% (CI 95% 61.6-69.9), 38.6% (CI 95% 34.4-42.8) had diabetes and 63.7% (CI 95% 59.4-67.9) had metabolic syndrome. The prevalence of left ventricular hypertrophy and left atrial enlargement, determined by echocardiography was 57.1% (CI 95% 50.8-63.5) and 10.0% (CI 95% 6.3-13.7) respectively. Microalbuminuria was found in 46.6% (CI 95% 41.4-51.8) of the subjects. Patients with metabolic syndrome were significantly older (65.4 ± 11 and 62.5 ± 12 years; P = .0052), presented a higher prevalence of diabetes (52.0% vs. 16.6; P < .0001) and were treated more frequently with ≥ 4 antihypertensive drugs (65.1 vs. 50.0%, P = .011). Conclusion The prevalence of central obesity, metabolic syndrome and target organ damage is very high in resistant hypertensive subjects.