Prevalence Of Resistant Hypertension Research Articles

Prevalence of resistant hypertension in patients treated in the institutions of a healthcare network in Peru

Prevalence of resistant hypertension in patients treated in the institutions of a healthcare network in Peru

Prevalence and determinants of resistant hypertension in the delta region of Egypt: A prospective observational study.

Hypertension (HTN) is a leading cause of morbidity and mortality affecting about 30%-40% of the adult population in developed countries. Fewer data were published about the prevalence, sociodemographics, and clinical characteristics of the resistant hypertensive population in Egypt. Hence, our aim is to focus the attention on these determinantsespecially in the delta region of Egypt. Data belonging to patients visiting our HTN clinic in the Cardiovascular Department, Tanta University Hospital, Gharbeyah Governorate, Egypt, were collected over 12 months, between January 1, 2022, and 31 December 31, 2022, and then carefully analyzed. We found that the prevalence of resistant hypertension (RHTN) in the delta region of Egypt was 18%. We noted more RHTN cases in older age, that is, mean ± Std. was 51.5 ± 13.24 and 62.1 ± 7.56 for non-RHTN and RHTN, respectively. Also, the prevalence was higher in women representing about 54.4% of cases. Sixty-two percentof the patients with RH were obese (mean ± Std. of body mass indexwas 30.7 ± 5.36 in HTNand 47.7 ± 30.3 in RHTNgroups with p value <0.001). We found a significant relationship between chronic kidney disease, diabetes, and RHTN. Control of HTN among the Egyptian population in the delta region was unsatisfactory and higher than rates published globally. RH was more obvious in women, elderly, obese population, and diabetic and chronic kidney disease patients. Excessive use of nonsteroidal anti-inflammatory drugs, smoking, and high salt intake were clearly observed.

Clinical characteristics and outcomes of Chinese patients with coronary heart disease and resistant hypertension.

There is currently few research on clinical characteristics and outcomes of coronary heart disease (CHD) with resistant hypertension in central region of China. This study aimed to assess the risk factors and outcomes of CHD and resistant hypertension in population of central region of China. A total of 1467 CHD patients with hypertension were included and considered to three groups according to blood pressure control: controlled group (blood pressure<140/90mmHg on three or less antihypertensive drugs); uncontrolled group (blood pressure≥140/90mmHg on two or less antihypertensive drugs); or resistant group (blood pressure≥140/90mmHg on three antihypertensive drugs or<140/90mmHg on at least four antihypertensive drugs including diuretic). The authors evaluated the clinical outcomes of three groups at 1-year follow-up. The prevalence of resistant hypertension was 21.8%. Significant adjusted associated factors of resistant hypertension included per unit changes body mass index (BMI, OR 1.12), and four categorical variable diagnosis by yes or no: heart failure (HF, OR 2.62), left ventricular hypertrophy (LVH, OR 2.83), diabetes (OR 1.55), and chronic kidney disease (CKD, OR 1.63). In multiple adjusted Cox regression analysis, patients in resistant group had a higher risk of the primary outcome (HR, 2.14 [95% CI, 1.47-3.11]; p<.001). Moreover, the risk of atherosclerotic cardiovascular disease (ASCVD) in patients with resistant hypertension is also significantly increased (HR, 2.11 [95% CI, 1.39-3.20]; p<.001). In conclusion, resistant hypertension was a quite common and high proportion finding in patients with CHD and hypertension in central region of China, and these patients have a worse clinical prognosis.

Resistant hypertension: A stepwise approach.

Resistant hypertension can be challenging to manage, but a stepwise approach to diagnosis, evaluation, and treatment can lead to better blood pressure control. In this article, we review the definition and prevalence of resistant hypertension and its diagnostic workup and management, including lifestyle modifications, drugs, and experimental interventional therapies.

Polygenic Susceptibility to Hypertension and Blood Pressure Control in Stroke Survivors.

Blood pressure (BP) is often not at goal in stroke survivors, leaving individuals vulnerable to additional vascular events. Given that BP is a highly heritable trait, we hypothesize that a higher polygenic susceptibility to hypertension (PSH) leads to worse BP control in stroke survivors. We conducted a study within the UK Biobank evaluating persons of European ancestry who survived an ischemic or hemorrhagic stroke. To model the PSH, we created polygenic risk scores (PRSs) for systolic and diastolic BP using 732 genetic variants. We divided the PRSs into quintiles and used linear/logistic regression to test whether higher PSH led to higher observed BP, uncontrolled BP (systolic BP > 140 mm Hg or diastolic BP > 90 mm Hg), and resistant BP (uncontrolled BP despite being on ≥3 antihypertensive drugs). We conducted an independent replication using data from the Vitamin Intervention for Stroke Prevention (VISP) trial. We analyzed 5,940 stroke survivors. When comparing stroke survivors with very low vs very high PSH, the mean systolic BP was 137 (SD 18) vs 143 (SD 20, p < 0.001), the mean diastolic BP was 81 (SD 10) vs 84 (SD 11, p < 0.001), the prevalence of uncontrolled BP was 42.8% vs 57.2% (p < 0.001), and the prevalence of resistant hypertension was 3.9% vs 11% (p < 0.001). Results remained significant using multivariable models (p < 0.001) and were replicated in the VISP study (all tests with p < 0.05). A higher PSH is associated with worse BP control in stroke survivors. These findings point to genetic predisposition as an important determinant of poorly controlled BP in this population.

Prevalence of resistant hypertension and its relation with plasma lipoprotein-associated phospholipase A2

Prevalence of resistant hypertension and its relation with plasma lipoprotein-associated phospholipase A2

S-16-6: NATRIURETIC PEPTIDES AND HUMORAL FACTORS IN CARDIORENAL SYNDROME AND RESISTANT HYPERTENSION

Hypertension is one of the strongest and modifiable risk factors for cardiovascular disease, and a variety of antihypertensive agents and treatment modalities have been developed in these 6 decades. In Japan, however, among the patients with hypertension, ∼75% fail to reach an optimal goal of target blood pressure, and 10–15% of the patients are referred to as resistant hypertension. There are a number of factors for resistant hypertension; especially, the prevalence of resistant hypertension is reported to be 2–3 times higher in patients with chronic kidney disease (CKD) than in the general hypertensive population. CKD has become a major challenge to public health all over the world, and one of the reasons for increased morbidity should be the increasing prevalence of cardiometabolic (or metabolic kidney) disease including diabetic kidney disease. Considering them, novel therapeutic strategies are eagerly being sought. We have studied the roles of vasoactive hormones, such as natriuretic peptides and aldosterone, and local humoral regulators in the pathophysiology of CKD. We have especially focused on metabolic renal disease, including diabetic nephropathy, nephrosclerosis, and renal fibrosis as their common consequence. Using genetically engineered mouse models, we demonstrated the renoprotective role of natriuretic peptides (ANP, BNP) against diabetic nephropathy, immune-mediated renal injury as well as renal fibrosis by subtotal renal ablation. Furthermore, using natriuretic peptide receptor (GC-A)-deficient mice coupled with aldosterone-induced renal injury, we found a renoprotective role of natriuretic peptides on podocytes independent of their antihypertensive action, by inhibiting the local RAS-MAPK-cytokine cascade activation. From recent GWAS analyses, gene polymorphisms related to the natriuretic peptide system are found to be strongly associated with hypertension and cardiovascular disease, suggesting their critical role in cardiovascular homeostasis and blood pressure control. Angiotensin receptor-neprilysin inhibitor (ARNI) is a new class of anti-hypertensive agents characterized by its dual action with renin-angiotensin system blockade and inhibition of natriuretic peptide degradation. In recent clinical trials, ARNI has been shown to have significant cardio-renoprotective effects with a potent antihypertensive property. These findings together could show potential molecular targets, providing a promise for novel therapeutic approaches against CKD with resistant hypertension, metabolic renal disease and related cardiovascular complications.

Novel Therapies on the Horizon of Hypertension Management.

The rates of uncontrolled hypertension, along with downstream cardiovascular outcomes, has been worsening in this country. Despite the plethora of antihypertensive medications on the market, the prevalence of resistant hypertension (RH) is estimated to be 13.7%. Therefore in addition to increased clinical education and focus on lifestyle management of hypertension and medication compliance, new therapies are needed to address this rise in hypertension. A systematic review of the available medical literature was performed to identify emerging treatment options for RH. Six different pharmacologic classes and 2 procedural interventions were identified as being appropriate for review in this paper. The pharmacologic classes to be explored are non-steroidal mineralocorticoid receptor antagonists, aminopeptidase A inhibitors, dual endothelin antagonists, aldosterone synthetase inhibitors, atrial natriuretic peptide inhibitors, and attenuators of hepatic angiotensinogen. Discussion of procedural interventions to lower blood pressure will focus on renal denervation and devices that increase carotid baroreceptor activity. Promising medication and procedural interventions are being developed and studied to expand our treatment arsenal for patients with uncontrolled essential hypertension and RH.

Relationship Between Risks for Obstructive Sleep Apnea, Resistant Hypertension, and Aldosterone Among African American Adults in the Jackson Heart Study.

African Americans have a higher prevalence of resistant hypertension compared with Caucasians. Racial differences in obstructive sleep apnea (OSA) and increased aldosterone level may explain the racial disparity in resistant hypertension prevalence. Therefore, the purpose of this study is to investigate if aldosterone level and hypertension status differ by risks for OSA (e.g., obesity, loud snoring, and daytime sleepiness) and how aldosterone level varies with hypertension severity and control among African Americans. A cross-sectional analysis was performed using baseline data on 5,052 African American adults in the Jackson Heart Study to investigate the relationships of interest using multivariable linear and multinomial logistic regression models adjusted for potential confounders. Risks for OSA were defined by a "risk score" consisting of the number of risks for OSA. Of the 5,052 participants, 623 had no risks for OSA. Body mass index was the highest among those with a risk score of 6. About 39% of the sample had no hypertension, 29% had controlled hypertension, 26% had uncontrolled hypertension, and 6% had resistant hypertension. Higher odds of having uncontrolled hypertension or resistant hypertension were present in those with a higher risk score compared with those without risks for OSA. Log-aldosterone level increased with each additional risk for OSA (P-trend <0.05). Similarly, log-aldosterone also increased with more severe hypertension (P-trend <0.001). The highest aldosterone level was found in those with resistant hypertension that was inadequately controlled with medications. Risks for OSA were positively associated with resistant hypertension and higher aldosterone level in African American adults.

Renal denervation in resistant hypertension: a review of clinical trials and future perspectives.

A previous report using the National Health and Nutrition Examination Survey demonstrated an increase in the prevalence of resistant hypertension, which does not respond to traditional therapy and medication. Studies using various animal hypertensive models have demonstrated significant blood pressure (BP) reduction following renal artery denervation (RDN). Catheter-based RDN became available in clinical trials as a possible treatment option for resistant hypertension. Although first clinical trials of RDN have demonstrated the efficacy and safety of this treatment mortality for lowering BP in patients with resistant hypertension, the role of RDN has been questioned since the results of the Symplicity HTN-3 trial. Considering the ethnic differences demonstrated in the Symplicity HTN-Japan and Global Symplicity registry, by contrast, RDN might be an effective for resistant hypertension in Asian population. Here, we discuss RDN applications and technology, the old and new clinical evidence of RDN, patients' selection of RDN responder, and optimization of RDN procedure in this review. The available evidence demonstrates that RDN could be effective in carefully selected patients with resistant hypertension, paving the way for future research in this area.

Concurrent Primary Aldosteronism and Renal Artery Stenosis: An Overlooked Condition Inducing Resistant Hypertension.

To explore the clinical features of coexisting primary aldosteronism (PA) and renal artery stenosis (RAS), we retrospectively analyzed records from 71 patients with PA with RAS and a control group of 121 patients with PA without RAS. Aldosterone-to-renin concentration ratio tests and computerized tomography (CT) scanning of the adrenal and renal arteries were routinely conducted to screen for PA and RAS. Color Doppler flow and/or magnetic resonance imaging were used as substitute testing of patients for whom CT was contraindicated. Standard percutaneous renal arteriography (PTRA) was considered for patients with RAS exceeding 70% based on non-invasive tests and for those without PTRA contraindications. The patients with PA with RAS were further divided into severe (RAS>70%) and moderate (50% < RAS <70%) RAS groups. The prevalence of RAS among PA patients was 6.9% (71/1,033), including 3.2% (33/1,033) with severe RAS. Compared with the PA without RAS group, the severe RAS group showed higher levels of systolic blood pressure (SBP) (171.82 ± 18.24 vs. 154.11 ± 18.96 mmHg; P < 0.001) and diastolic BP(DBP) (110.76 ± 15.90 vs. 91.73 ± 12.85 mmHg; P < 0.001) and prevalence of resistant hypertension (RH) (90.9 vs. 66.9%; P = 0.008), whereas the moderate RAS group merely showed higher DBP (98.63 ± 14.90 vs. 91.73 ± 12.85 mmHg; P = 0.006). The direct renin concentrations (DRCs) (5.37 ± 3.94 vs. 3.71 ± 2.10 μU/mL; P < 0.001) and false-negative rate (33.8 vs. 3.3%; P < 0.01) of PA screening tests were significantly higher in the PA with RAS group than in the control group, but only in severe RAS group, in subgroup analysis. Among patients who underwent successful treatment for severe RAS, mean DRC decreased from 11.22 ± 9.10 to 3.24 ± 2.69 μIU/mL (P < 0.001). Overall, the prevalence of RH decreased from 81.7 to 2.8% (P < 0.001) when both PA and RAS were treated with standard methods. PA with concurrent severe RAS is a condition that induces RH. PA can be easily missed in patients with coexisting RAS. RAS patients with RH after successful revascularization for RAS should be evaluated for coexisting PA.

The Burden of Resistant Hypertension Across the World.

Resistant hypertension (R-HTN) is related to worse cardiovascular, renal outcomes, and death compared to non R-HTN. We aimed to review the burden of R-HTN across the world, focusing on its prevalence, associated factors and outcomes, and the impact of treatment. R-HTN prevalence among hypertensive individuals varies around 10-20%, depending on the population and definition applied. R-HTN consistently relates to older age, chronic kidney disease, obesity, and obstructive sleep apnea - which are increasing in prevalence with global population aging. As such, R-HTN prevalence is also expected to rise. Infrequent use of ambulatory blood pressure monitoring to identify at higher risk individuals and poor adherence to treatment are still barriers in the approach of R-HTN. Available evidence suggests that 10-20% of patients with hypertension have R-HTN. However, the prevalence of true R-HTN using contemporaneous standardized definitions is still unknown. Novel strategies to address clinicians, patients and health system barriers to treatment inertia and adherence are fundamental to reduce the burden of R-HTN.

Prevalence of resistant hypertension in uncontrolled hypertensive patients seen in consultation

Resistant hypertension is defined by hypertension not controlled in consultation and confirmed by measurement outside the doctor's office, despite a therapeutic strategy comprising adapted hygiene and dietetic rules and antihypertensive triple therapy for at least 4 weeks, at optimal dose, including a thiazide diuretic. Screening for resistant hypertension in internal medicine and cardiology consultation. Prospective study including 1862 hypertensive patients, aged 18 and over, treated for at least one year and referred for uncontrolled hypertension, seen between October 2015–December 2019. The verification of the non-achievement of the blood pressure target was performed in all patients, either by ambulatory blood pressure measurement (ABPM) or by AMT (self-measurement of blood pressure), and revealed a blood pressure target not reached each time. Of the 1862 patients screened, mean age 58 ± 13.4 years, including 838 men (45%), and 1024 women (55%), 896 (48%) were receiving non-optimal treatment, 45% of patients had a BMI greater than 30 kg/m 2 (41% men vs. 59% women), 23% were smokers, and 45% were diabetics. In total, 612 (32.8%) were poor observers and 202 (8.5%). A secondary cause of hypertension was identified in 175 (9.4%) patients. Finally, only 112 patients presented with hypertension requiring quadruple therapy or more, either a prevalence of 6.01% (95% CI: 5.6–7.2). It should be noted that three of our patients benefited from renal denervation practiced in our department, the immediate responses were satisfactory. Less than 15% of the patients referred to our consultation present a true hypertension, and almost half present a pseudo-resistance. The majority of patients with apparently resistant hypertension can achieve the blood pressure goal if they are sensitized, observant, and properly treated.

A Japan nationwide web-based survey of estimation on patients for renal denervation based on blood pressure level and the number of antihypertensives (J-NEEDs survey).

Catheter‐based renal denervation (RDN) is currently being developed as a new complementary treatment option for hypertension. RDN has not yet received approval in Japan and so the number of possible candidates for RDN in Japan also remains unknown. A total of 10 756 hypertensive patients who regularly visit medical institutions and reported their latest home blood pressure (BP) values were identified from registrants at an online research company. They filled out a survey regarding their prescribed antihypertensives and latest BP values in March 2020 in Japan. The mean age of the patients was 61.3 years old (83.5% male). According to JSH 2019, the prevalence of resistant hypertension (RHT) was estimated to be 1.4% (0.52% having an office BP of 140/90 mm Hg or more while taking three antihypertensives, including diuretics; 0.84% taking four or more antihypertensives regardless of BP level). Assuming the indication for RDN was RHT with morning home systolic BP (HSBP) ≥ 135 mm Hg and office systolic BP (OSBP) ≥ 140 mm Hg, the number of candidates for RDN was estimated to be approximately 340 000 and 372 000, respectively. When hypertensive patients prescribed three or more, two, one, and no antihypertensives were included, the estimated number based on uncontrolled HSBP and OSBP cumulatively increased 2.6, 14.2, 40.6, and 58.0‐fold; 1.8, 8.6, 25.3, and 36.4‐fold, respectively. These findings revealed that a substantial number of hypertensive patients are unable to adequately control their BP level with existing treatments, and new complemental therapies, such as RDN, would alleviate the burden of hypertension in this population.

Hypertension in Chronic Kidney Disease (CKD): Diagnosis, Classification, and Therapeutic Targets

Blood pressure (BP) in the office is often recorded without standardization of the technique of measurement. When office BP measurement is performed with a research-grade methodology, it can inform better therapeutic decisions. The reference-standard method of ambulatory BP monitoring (ABPM) together with the assessment of BP in the office enables the identification of white-coat and masked hypertension, facilitating the stratification of cardiorenal risk. Compared with general population, the prevalence of resistant hypertension is 2- to 3-fold higher among patients with chronic kidney disease (CKD). The use of ABPM is mandatory in order to exclude the white-coat effect, a common cause of pseudoresistance, and confirm the diagnosis of true-resistant hypertension. After the premature termination of Systolic Blood Pressure Intervention Trial due to an impressive cardioprotective benefit of intensive BP-lowering, the 2017 American Heart Association/American College of Cardiology guideline reappraised the definition of hypertension and recommended a tighter BP target of <130/80 mm Hg for the majority of adults with a high cardiovascular risk profile, inclusive of patients with CKD. However, the benefit/risk ratio of intensive BP-lowering in particular subsets of patients with CKD (i.e., those with diabetes or more advanced CKD) continues to be debated. We explore the controversial issue of BP targets in CKD, providing a critical evaluation of the available clinical-trial evidence and guideline recommendations. We argue that the systolic BP target in CKD, if BP is measured correctly, should be <120 mm Hg.

An improvement in self-care behaviour in heart failure patients lead to better management of hypertension

Abstract Background A common heart failure (HF) aetiology is hypertension (HTN), second only to ischemic heart disease and with a prevalence in the HF community of between 62% and 84%, depending on sex and ejection-fraction. Undertreated HTN leads to worse prognosis and resistant HTN is defined as blood pressure (BP) exceeding 140/90 mmHg, in spite of pharmacological treatment. Since one constituent of self-care behaviour is treatment adherence, we wished to study whether patients exposed to a digital intervention shown to improve self-care behaviour, would also display improved BP control. Methods SMART-HF was a randomized controlled trial, recruiting patients from seven centres in Region Skåne in southern Sweden, where patients in the intervention group (IG) were equipped with a digital home-based tool, designed to enhance self-care behaviour for HF-patients and the control group (CG) were subject to standard care. BP data was registered at baseline and after eight months of intervention and self-care behaviour was measured using the European Heart Failure Self-care Behaviour Scale (EHFScB). We used a Chi-square test to analyse whether there was an inter-group difference of prevalence of resistant HTN or a mean arterial pressure (MAP) outside the recommended range of 60 mmHg &amp;lt; MAP &amp;lt;100 mmHg. Results Out of the 118 patients included in the original analysis, 92 (78%) had complete BP measurements. At baseline there was no difference in self-care behaviour between the groups, with CG: 25 [17.5; 32] and IG: 24.5 [18; 30], p=0.61, and 28% of the CG patients and 24% of the IG population displayed resistant HTN, p=0.73. After eight months of intervention the IG had 21% (or 4.5 points) better self-care behaviour compared to the CG, p=0.014, and the fraction of patients with resistant HTN was 30% for the CG and 11% for the IG, p=0.027. There was also a significant effect on the fraction of patients having a MAP &amp;gt;100 mmHg, with 22% in the CG versus 16% in the IG having MAP &amp;gt;100 mmHg at baseline (p=0.39) and 19% in the CG versus 0% in the IG at follow-up (p=0.002). Conclusions There was a significant improvement in self-care behaviour and also a significant reduction in the number of patients with resistant hypertension and elevated mean arterial pressure after eight months of intervention. Funding Acknowledgement Type of funding source: None

Resistant Hypertension in Chronic Kidney Disease (CKD): Prevalence, Treatment Particularities, and Research Agenda.

To explore the prevalence, treatment particularities, and research agenda in the management of resistant hypertension among patients with chronic kidney disease (CKD). The prevalence of resistant hypertension is reported to be 2-3 times higher in patients with CKD than in the general hypertensive population. Based in part on the results of the PATHWAY-2 trial showing add-on spironolactone to be superior to placebo or active treatment with an α- or β-blocker in reducing BP, international guidelines recommend the use of spironolactone as fourth-line agent in pharmacotherapy of resistant hypertension. Despite the several-fold higher burden of resistant hypertension among patients with stage 3b-4 CKD, the use of spironolactone in this population has been restricted, mainly due to the risk of hyperkalemia. The recently reported AMBER trial showed that among patients with uncontrolled resistant hypertension and an estimated glomerular filtration rate of 25-45ml/min/1.73m2, the newer potassium-binder patiromer prevented the development of hyperkalemia and increased the proportion of participants who remained on add-on spironolactone over 12weeks of follow-up. Administration of spironolactone was associated with a clinically meaningful reduction of 11-12mmHg in unattended automated office systolic blood pressure (BP) over the course of the AMBER trial. Newer potassium-binding therapies overcome the barrier of hyperkalemia and facilitate the persistent use of spironolactone, which is an effective add-on therapy to control BP in patients with resistant hypertension and advanced CKD. Future trials are now warranted to explore whether this strategy confers benefits on "hard" clinical outcomes in this high-risk population.

2-2PROFILE OF RESISTANT HYPERTENSION IN THE UNIVERSITY CHRISTIAN OF INDONESIA GENERAL HOSPITAL IN 2019

Hypertension is one of the leading causes of mortality and morbidity in Indonesia. Resistant hypertension is a case of hypertension whose blood pressure remains high, after a change in lifestyle and obtaining management of 3 anti-hypertensive drugs with optimal doses with a different mechanism of action. The exact prevalence of HR is not known with certainty. The lack of data on the prevalence of resistant hypertension is the aim of this study to complete the data on the prevalence of resistant hypertension in UKI General Hospital. This research is descriptive. Data is taken from UKI General Hospital medical records from January to December 2019 with inclusion and exclusion criteria. Of the 1,030 in patients with hypertension, 139 patients are suffering from resistant hypertension. With the number of men and women not very different, the average age is 58 years, and most cases are in the age group&gt; 65 years. Chronic kidney failure (CKD) is the most common comorbid disease, followed by DM and heart failure. Patients with more resistant hypertension have very high initial blood pressure, and most use a combination of 3 drugs to control their blood pressure.

Treatment resistant hypertension among ambulatory hypertensive patients: A cross sectional study.

BackgroundTreatment resistant hypertension(TRH) is detrimental risk of cardiovascular and premature deaths. Globally, the prevalence of resistant hypertension is inclining from time to time and it is yet to be determined in Ethiopia.ObjectiveTo assess the prevalence of apparent TRH and its predictors among ambulatory hypertensive patients on follow up in hypertension clinic of Mekelle Hospital, Northern Ethiopia.MethodA hospital based cross sectional study was conducted from Nov 25, 2018 to July 20, 2019, among 338 adult ambulatory hypertensive patients on follow up in Mekelle Hospital hypertension clinic. Hypertensive patient aged ≥18 years who were on regular follow up and taking antihypertensive medications for at least 6 months were included in the study. A simple random sampling technique was used to recruit the study patients.ResultsA total of 338 adult ambulatory hypertensive patients were analysed. More than half, 182 (53.8%) patients were females and the average age of the patients was 58.9 ±11.5. Three hundred thirty-three (98.5%) patients had no family history of hypertension. Majority, 66.8% of the patients were on monotherapy. The prevalence of apparent TRH was calculated to be 8.6% [Confidence Interval = 0.056–0.116]. Patients with Body Mass Index(BMI) greater than 30[Adjusted Odds Ratio(AOR) = 12.1, 95%CI:2.00–73.19, p = 0.007] and longer duration of hypertension were the predictors of resistant hypertension.ConclusionEven if escalation of antihypertensive medications was not aggressive, apparent TRH was common in the study setting. Obesity (BMI greater than 30) and longer duration of hypertension since diagnosis were the predictors of TRH. Meticulous emphasis should be placed on to detect the prevalence of true hypertension resistance and future studies should discover the impact of aggressive antihypertensive medications scale up on the risks of TRH.

Is There Any Role for Device Therapies in Resistant Hypertension? Commentary.

In this issue of Kidney360 , two titans of hypertension, Drs. Ray Townsend and Aldo Peixoto, debate whether there is any role for device therapies in resistant hypertension. As the debate’s moderator, I will provide background information to set the stage for this epic showdown and offer a nonpartisan opinion on the topic. First, what is meant by “resistant hypertension?” According to the most recent ACC/AHA High Blood Pressure Clinical Guidelines, the diagnosis of resistant hypertension is made when a patient takes three antihypertensive medications, including at least one diuretic, but does not achieve control or when BP control is achieved but requires four or more medications (1). Using the BP target of <130/80 mm Hg, the prevalence of resistant hypertension among United States adults taking antihypertensive medication is estimated at 20% or 10.3 million persons (2). Second, with so many different types of antihypertensive medications that can effectively and reliably lower BP, why turn to device therapy for hypertension management given the inherent risks that come with these invasive procedures? Many patients cannot or will not take antihypertensive medications as prescribed due to unacceptable side effects or other factors. Moreover, even patients with perfect medication adherence to multiple antihypertensive medications will sometimes still have poorly controlled BP (3). Thus, …