Cause Of Persistent Hypertension Research Articles

PP.16.35

Objective: Despite the availability of numerous therapeutic agents and management tools, nearly half of all hypertensive patients do not have their blood pressure (BP) at goal (HSCIC data). Proteus captures and shares information about medication-taking, rest and activity patterns through an FDA-cleared and CE-marked ingestible sensor (IS), a wearable sensor adhesive patch and a mobile device and app. This platform supports provider decision-making for treating patients to goal. An open-label, observational real-world registry study evaluated this product in patients with uncontrolled hypertension. Design and method: The target sample size of the registry study is 150 patients with uncontrolled hypertension prescribed at least 2 antihypertensives. Patients co-ingested the IS with prescribed BP medications while simultaneously wearing the patch for 2 weeks. Clinic BP was measured on days 1 and 14. Adherence, activity and rest patterns, were measured via the Proteus patch and IS. Subjects returned to the clinic at week 4 to discuss the next steps in therapy based on the Proteus data. Results: In this interim analysis, 46 patients met the inclusion/exclusion criteria. The mean age was 68, 51% were male, and 36% also had diabetes. The root cause of persistent hypertension was identified for 100% of subjects; 46% had pharmacological resistance and 54% had inadequate medication use. BP control was achieved in 37% of patients after 2 weeks. The mean systolic BP decreased from 158 ± 16 to 143 ± 16, and the mean diastolic BP decreased from 83 ± 12 to 77 ± 10 after 2 weeks. BP management changes included medication reviews and/or adherence counseling in 88%, and medication changes in 24% of patients. Most patients (84%) had a good experience and thought the Proteus platform was easy to understand and convenient to use as measured by a patient satisfaction survey. Conclusions: In patients with a history of uncontrolled hypertension, the Proteus platform was able to help identify the root cause of persistent hypertension and help 37% achieve BP control within 2 weeks. The Proteus platform demonstrates the potential to help providers identify specific factors contributing to uncontrolled hypertension and facilitates interventions to improve disease management.

English

Hypertension in childhood and adolescence is usually secondary to underlying causes like renovascular, renal-parenchymal, cardiovascular and endocrine diseases. Persistent hypertension in paediatric age group is a diagnostic and therapeutic challenge. Sleep disordered breathing or Obstructive sleep apnea in adolescence can present in numerous nonspecific ways. Whether sleep disordered breathing can solely be a cause of persistent hypertension in adolescence is doubted. We report a case of a 13 year old boy with history of persistent hypertension inadequately controlled even with multiple antihypertensive drugs. A thorough history, physical examination and rational investigations were performed to rule out causes of secondary hypertension. The patient was obese and obstructive sleep apnea was identified on the basis of history and sleep studies. He was titrated on continuous positive airway pressure (CPAP) for obstructive sleep apnea and put on a weight loss regimen. Amelioration of symptoms and adequate blood pressure control was obtained. We concluded that hypertension in adolescence may be caused or aggravated by sleep disordered breathing and a specific treatment approach may help in relieving symptoms and achieving adequate blood pressure control especially when no other etiology or risk factors can be identified.

Renal pathology in patients with primary hyperaldosteronism secondary to an adrenal cortical adenoma

The cause of persistent hypertension following the removal of an aldosterone-producing adrenal adenoma is unknown. The purpose of this study was to determine whether this occurrence is due to existing renal histopathologic damage. Thirty-two patients with primary hyperaldosteronism due to an aldosterone-secreting adrenal cortical adenoma underwent open renal biopsy at the time of unilateral adrenalectomy. Biopsy results were correlated with the duration and severity of hypertension before and after surgery. Nineteen patients were cured of their hypertension postoperatively, whereas 13 patients had persistent diastolic hypertension. Statistical analysis of these two groups revealed no difference when renal histopathologic variables, preoperative severity of hypertension, or preoperative duration of hypertension were compared. Persistent hypertension in these patients does not appear to be due to renal histopathologic changes; coexisting essential hypertension is a more likely cause.