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.
Objective: To compare the pulse wave velocity (PWV) results obtained by Sphygmocor AtCor Medical, by radial tonometry, and Mobil-Ambulatory Blood Pressure Monitor-Pulse Wave Velocity (Mobil-ABPM-PWV) 24 hours, an oscillometric method. Design and method: Sixty-three controlled hypertensive (41 female and 22 male) and sixty-three resistant hypertensive (36 female and 27 male) patients were recruited and submitted to evaluation of arterial stiffness by the SphygmoCor (radial tonometry) and by Mobil-ABPM-PWV (oscillometric method). Linear regression and Bland-Altmann test were used to statistics analysis. Results: The correlations of the PWV as assessed with Mobil-ABPM-PWV 24 hours with the values obtained using the SphygmoCor radial tonometry were significant (controlled hypertensive patients: r = 0.54, P < 0001; resistant hypertensive patients: r = 0.48, P < 0.001). Comparison Bland-Altman plot showed concordance correlation coefficient (controlled hypertensive patients = 5.0, P < 0.0001 and resistant hypertensive patients = 4.8, P < 0.0001). Figures 1–4. Conclusions: The oscillometric method Mobil-ABPM-PWV is an easy-to-use and time-effective method for assessing arterial stiffness compared with the SphygmoCor AtCor radial tonometry.
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.
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