Background The causal relationship between systemic arterial hypertension and target organ damage (TOD) is well known, as well as the association with cardiovascular risk factors (CV). Ambulatory blood pressure monitoring (ABPM) is important in monitoring hypertension and assessing the risk of TOD. Objective To evaluate the relationship between blood pressure (BP) and clinical and biochemical parameters in the development of TOD in hypertensive patients. Methods This was a retrospective cohort study with 162 hypertensive patients followed for an average period of 13 years. The TOD investigated were left ventricular hypertrophy (LVH), microalbuminuria, coronary artery disease (CAD) and stroke. Blood pressure was assessed by ABPM and LVH using echocardiogram and electrocardiogram, respectively. Biochemical-metabolic tests and 24-hour microalbuminuria were performed at baseline and follow-up. The P-value <0.05 was considered significant. Results The average age was 69±11.8 years, with a predominance of women (64.8%), white ethnicity (79.6%) and diabetics (78.4%). ABPM showed a significant reduction in BP values during follow-up, although without association with TOD (microalbuminuria, stroke, and CAD), except for LVH that showed a correlation with sleep BP ≥120/70 mmHg (P=0.044). The most frequent TODs were LVH (29.6%), microalbuminuria (26.5%), CAD (19.8%) and stroke (17.3%). In the follow-up, there was an association between LVH and diabetes; microalbuminuria was associated with diabetes and triglycerides; stroke was associated with HDL-cholesterol (HDL-c), microalbuminuria and carotid disease. CAD showed a relationship with age and HDL-c. Conclusion Predictive factors for TOD are age, microalbuminuria, diabetes, HDL-c, triglycerides and carotid disease. Nocturnal BP is correlated with LVH. The absence of a relationship between ABPM and other TODs can be explained by the use of effective drugs, improvement of metabolic and blood pressure parameters.

BackgroundResistant hypertension is characterized when the blood pressure (BP) remains above the recommended goal after taking three antihypertensive drugs with synergistic actions at their maximum recommended tolerated doses, preferably including a diuretic. Identifying the contribution of intravascular volume and serum renin in maintaining BP levels could help tailor more effective hypertension treatment, whether acting on the control of intravascular volume or sodium balance, or acting on the effects of the renin-angiotensin-aldosterone system (RAAS) on the kidney.Methods/designThis is a randomized, open-label, clinical trial is designed to compare sequential nephron blockade and its contribution to the intravascular volume component with dual blockade of the RAAS plus bisoprolol and the importance of serum renin in maintaining BP levels. The trial has two arms: sequential nephron blockade versus dual blockade of the RAAS (with an angiotensin converting enzyme (ACE) inhibitor plus a beta-blocker) both added-on to a thiazide diuretic, a calcium-channel blocker and an angiotensin receptor-1 blocker (ARB). Sequential nephron blockade consists in a progressive increase in sodium depletion using a thiazide diuretic, an aldosterone-receptor blocker, furosemide and, finally, amiloride.On the other hand, the dual blockade of the RAAS consists of the progressive addition of an ACE inhibitor until the maximum dose and then the administration of a beta-blocker until the maximum dose. The primary outcomes will be reductions in the systolic BP, diastolic BP, mean BP and pulse pressure (PP) after 20 weeks of treatment. The secondary outcomes will evaluate treatment safety and tolerability, biochemical changes, evaluation of renal function and recognition of hypotension (ambulatory BP monitoring (ABPM)). The sample size was calculated assuming an alpha error of 5% to reject the null hypothesis with a statistical power of 80% giving a total of 40 individuals per group.DiscussionIn recent years, the cost of resistant hypertension (RH) treatment has increased. Thus, identifying the contribution of intravascular volume and serum renin in maintaining BP levels could help tailor more effective hypertension treatment, whether by acting on the control of intravascular volume or sodium balance, or by acting on the effects of the RAAS on the kidney.Trial registrationSequential Nephron Blockade vs. Dual Blockade Renin-angiotensin System + Bisoprolol in Resistant Arterial Hypertension (ResHypOT). ClinicalTrials.gov, ID: NCT02832973. Registered on 14 July 2016. First received: 12 June 2016. Last updated: 18 July 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-2343-3) contains supplementary material, which is available to authorized users.

Resistant hypertension (RH) is characterized by the use of three or more antihypertensive drugs without reaching the goal of controlling blood pressure (BP). For a definitive diagnosis of RH, it is necessary to exclude causes of pseudoresistance, including the white-coat effect, errors in BP measurement, secondary hypertension, therapeutic inertia, and poor adherence to lifestyle changes and pharmacological treatment. Herein, we report the history of a patient with long-standing uncontrolled BP, even when using seven antihypertensive drugs. Causes of secondary hypertension that justified the high BP levels were investigated, in addition to the other causes of pseudo-RH. In view of the difficult-to-control BP situation, it was decided to hospitalize the patient for better investigation. After 5 days, he had BP control with practically the same medications previously used. Finally, all factors related to the presence of pseudo-RH are discussed, especially poor adherence to treatment. Poor adherence to antihypertensive treatment is common in daily medical practice, and its investigation is of fundamental importance for better management of BP.

Objective: To compare the influence of dietary sodium intake through 24-hours urinary sodium excretion (Na + Ur24 h) on arterial stiffness markers in controlled and resistant hypertensive individuals. Design and method: 126 patients were randomized in an observational and cross-sectional study, divided into two groups: 63 in the controlled hypertension group (CHTN) and 63 in the resistant hypertension group (RHTN). All were submitted to clinical evaluation, laboratory tests, Na + Ur24 h and non-invasive central hemodynamic evaluation by the SphygmoCor® and Mobil-O-Graph® system to determine arterial stiffness parameters. Results: Clinical characteristics and laboratory tests were similar in both groups. There was no statistical significance between CHTN and RHTN for Na + Ur24 h values (186.60 ± 92.15 vs.179.76 ± 66.91 mEq/L, respectively). The carotid-femoral pulse wave velocity (cfPWVc) showed no statistically significant difference between CHTN and RHTN (10.52 ± 2.47 m/s vs. 10.21 ± 2.27 m/s, respectively). Central hemodynamic parameters were statistically different between the groups assessed by 24-hour ambulatory blood pressure monitoring (ABPM - Mobil-O-Graph®). RHTN group had higher cardiac output during sleep and greater vascular resistance during wakefulness and 24 hours than CHTN group (p < 0.05) in ABPM. Conclusions: Na + Ur24 h excretion is similar between groups, but there is better adherence to dietary sodium intake restriction in the resistant hypertension group. Physiological hemodynamic parameters are altered in the RHTN group, such as cardiac output and peripheral vascular resistance, a fact that evidences their participation in the pathophysiological process of resistant hypertension.

Background Systemic arterial hypertension (SAH) is one of the major risk factors related to the development of cardiovascular diseases (CVD). Sodium intake is linked to elevated blood pressure and can be estimated by 24-h urinary sodium excretion. The objective of this study was to correlate 24 h urinary sodium excretion, blood pressure and arterial stiffness (AS) parameters in hypertensive individuals. Methods We evaluated 53 patients who underwent in-office 24-h blood pressure tests and AS parameters using the Mobil-O-Graph® equipment. Te patients were divided into controlled hypertensive and resistant hypertensive. Unpaired t-test was performed with significance at p < 0.05. Results Mean age was 64.32 years; weight 77.56 kg; height 1.61 m; and BMI of 29.68 kg/m2. Resistant hypertensive patients (25 subjects) have systolic blood pressure (SBP) (p < 0.0001), diastolic blood pressure (DBP) (p = 0.004), 24 h SBP (p < 0.0001), 24 h DBP (p = 0.002), pulse pressure (PP) (p < 0.0001), central systolic blood pressure (cSBP) (p = 0.0003) and central diastolic blood pressure (cDBP) (p = 0.021) higher than controlled hypertensive patients (28 subjects). Conclusion Peripheral and central arterial pressures are higher in resistant hypertensive than in controlled hypertensive. Sodium excretion is unrelated to hemodynamic variables. Age is related to the elevation of central pressure and pulse wave velocity.

Introduction Hypertension is the most important modifiable risk factor for cardiovascular disease and a leading public health concern. Objectives The primary aim was to compare sequential nephron blockade (SNB) versus dual renin-angiotensin system blockade (DRASB) plus bisoprolol in patients with resistant hypertension to observe reductions in systolic and diastolic blood pressure (SBP and DBP) levels after 20 weeks of treatment. Material and Methods This trial was an open-label, prospective, randomized, parallel-group, clinical study with optional drug up-titration. Participants were evaluated during five visits at 28-day intervals. Results The mean age was 55.5 years in the SNB and 58.4 years in the DRASB + bisoprolol group (p=NS). Significant office BP reductions were observed in both groups. SNB group, SBP decreased from 174.5±21.0 to 127.0±14.74 mmHg (p<0.0001), and DBP decreased from 105.3±15.5 to 78.11±9.28 mmHg (p<0.0001). DRASB group, SBP decreased from 178.4±21.08 to 134.4 ± 23.25 mmHg (p<0.0001) and DBP decreased from 102.7±11.07 to 77.33±13.75 mmHg (p<0.0001). Ambulatory blood pressure monitoring (ABPM) showed also significant SBP and DBP reductions in both groups (p<0.0001). Conclusion In patients with RHTN adherent to treatment, SNB and DRASB plus bisoprolol showed excellent therapeutic efficacy, although SNB was associated with earlier SBP reduction.