Refractory Hypertension

Abstract

See related article, p 451–458 Calhoun et al1 in this edition of the journal report on an important clinical phenotype: refractory hypertension. They provide important information on the prevalence, risk factors, and comorbidities for refractory hypertension in a large observational study, including adults from across the United States.2 They note that 0.5% of the patients receiving antihypertensive treatment and 3.6% of the individuals with resistant hypertension had refractory hypertension. These observations are of great importance and provide key evidence that true antihypertensive treatment failure is uncommon. Moreover, the observations also help us appreciate the paradox that with an increasing number of medications needed to treat hypertension, there is an association with greater proclivity for refractory hypertension. In their study, they note that patients of African descent, and those with albuminuria and diabetes mellitus, were more likely to have refractory hypertension, even after multivariable adjustment. Moreover, individuals with refractory hypertension had a much higher 10-year Framingham coronary heart disease and stroke risk score than those without. This observation underscores the importance of hypertension as a major risk factor for promoting cardiovascular disease. So what is the cause of refractory hypertension? …