Abstract
Background and Objective: 24-h ambulatory blood pressure monitoring (ABPM) aids to precisely identify patients with true resistant hypertension (tRH). The present study was aimed to assess the frequency and correlates of tRH among patients with clinically suspected RH. Methods: Medical records of treated hypertensive patients referred in four healthcare centers for BP control evaluation by 24-h ABPM were reviewed to assess the prevalence of tRH. Inclusion criteria were age ≥ 18 years, clinical diagnosis of RH. Data on demographic, clinical, laboratory, 2D-echocardiography and 24-h ABPM parameters were retrieved from patient’s medical records. True RH (tRH) was defined as office blood pressure (BP) ≥ 140/90 mmHg and 24-h ambulatory BP ≥ 130/80 mmHg. Simple and multiple linear regression analyses were used to assess factors associated with systolic BP (SBP) as a proxy of RH among patients with tRH. P 0.05 defined the level of statistical significance. Results: Of 636 patients referred for BP control evaluation by 24-h ABPM, 75 (11.7%) had suspected RH by office BP measurements. After 24-h ABPM, pseudo or apparent RH (aRH) and tRH were observed in 15 (2.3%) and 60 (9.4%) patients, respectively. BMI (p = 0.007) and blood glucose (p = 0.024) were positively associated with SBP whereas a negative association was observed with eGFR (p = 0.022) among tRH hypertensive patients in multiple regression analysis. Conclusion: True RH was a common finding among patients with clinical RH and associated with obesity and silent target organ, especially kidney dysfunction. The present study highlights the diagnostic and prognostic importance of 24-h ABPM among patients with clinical RH.
Highlights
In sub-Saharan Africa (SSA), very low rates of blood pressure (BP) control may predict an increased prevalence of resistant hypertension (RH) across the continent [1]
Medical records of treated hypertensive patients referred in four healthcare centers for BP control evaluation by 24-h ambulatory blood pressure monitoring (ABPM) were reviewed to assess the prevalence of true resistant hypertension (tRH)
As the diagnosis of RH is based on office BP measurements, its prevalence may be influenced by the white coat phenomenon [5] [6]
Summary
In sub-Saharan Africa (SSA), very low rates of blood pressure (BP) control may predict an increased prevalence of resistant hypertension (RH) across the continent [1]. As the diagnosis of RH is based on office BP measurements, its prevalence may be influenced by the white coat phenomenon [5] [6] In this regard, previous studies have found that about one third of subjects with clinically suspected RH have “apparent or pseudo-resistant” hypertension (aRH) (office BP ≥ 140/90 mmHg and 24-h ABPM < 130/80 mmHg) when using 24-h ABPM. ABPM, a technique of obtaining automated brachial BP measurements at fixed time intervals, during a 24-hour period away from a medical environment, represents a more “realistic” approach to BP assessment. It involves measurement of BP during the usual daily activities and sleep and estimates more accurately the overall hemodynamic load and BP variability [6]. The present study was aimed to asses, using 24-h ABPM, the frequency and clinical profile of “true” RH (tRH) among patients with clinically suspected RH
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