PS-C33-1: CIRCADIAN RHYTHM DISTURBANCES AND BLOOD PRESSURE LEVELS IN OBESE PATIENTS WITH TRUE AND PSEUDO-RESISTANT HYPERTENSION

Abstract

Background: The aim was to conduct a comparative assessment of the circadian rhythm (CR) abnormalities and blood pressure (BP) levels between pseudo- and true resistant hypertension (RH) in obesity. Methods: The study included 302 patients with uncontrolled hypertension and obesity. Initial treatment efficacy was assessed 3 months after dual therapy was administered. Those patients who did not reach target BP in dual therapy were transferred to triple therapy. Among patients who received triple therapy, 69 people did not reach target BP. All patients were additionally examined 6 months after the therapy initiation. Results: In the absence of a difference in BP levels, patients who subsequently become resistant, already at the stage of inclusion, significantly more often had a violation of CR with a predominance of the non-dipper rhythm. After 3 months of follow-up, there was a significant difference in the indicators of both office and out-of-office BP in resistant and non-resistant patients; however, the distribution of CR remained the same as at the stage of inclusion in the study. Despite the achievement of target BP after 6 months of therapy, in the majority (91.42%) of patients without resistance, the circadian rhythm normalized, while resistant patients had a normal CR only in 60.87%. At the stage of enrolling patients into the study and 3 months after the start of therapy there was no significant difference in BP levels between true and pseudo-resistance, then after 6 months of therapy, patients with true resistance had significantly higher office SBP (p < 0.01) and 24 h average SBP according to ABPM data (p < 0.05) compared with pseudo-resistant patients. Already at the stage of inclusion in the study, the normal CR in patients with true resistance was significantly less common than in patients with pseudo-resistance, and during the prescribed therapy, a similar trend persisted: after 6 months of antihypertensive therapy, 71.05% of pseudo-resistant patients had a normal CR, while with true resistance only about half of the patients had a normal CR. Conclusions: Even when target BP levels in antihypertensive therapy are achieved, obese patients with resistant hypertension are characterized by more pronounced disturbances of CR (most often in the form of non-dipper) and higher levels of office and out-of-office BP, compared with non-resistant patients. Compared with pseudo-resistant patients, the presence of true resistance in obesity is associated with higher SBP levels and a higher incidence of CR disturbances.