Refractory hypertension is a novel phenotype of antihypertensive treatment failure. The terms "refractory hypertension" and "resistant hypertension" were considered interchangeable for a long time and related to difficult-to-treat hypertension. Recently, the term "refractory hypertension" refers to a very small group of patients who do not really reach the target blood pressure for maximum antihypertensive therapy. In this review we discuss similarities and contrasts definition, prevalence, patient characteristics, risk factors, and possible underlying etiologies of refractory and resistant hypertension.
Aim. To assess the incidence of cardiovascular and cerebrovascular events in patients with controlled and uncontrolled hypertension, controlled resistant and uncontrolled resistant hypertension, refractory hypertension, and probably resistant and probably refractory hypertension. Materials and methods. A telephone call was made to 256 patients with hypertension included in the database to assess the incidence of cardiovascular and cerebrovascular diseases. All responding patients were divided into 7 groups according to the classification of hypertension based on the achievement/non-achievement of target blood pressure values and the number of drugs taken (controlled and uncontrolled hypertension, controlled resistant and uncontrolled resistant hypertension, refractory hypertension, and probably resistant and probably refractory hypertension). The target blood pressure was considered to be less than 140/90 mm Hg. Patients not adhering to medication were not included in the analysis. Results. The group of controlled hypertension included 146 (57%) patients out of 256, controlled resistant hypertension 36 (14%) patients, uncontrolled hypertension 6 (2.3%) patients, resistant uncontrolled hypertension 22 (8.6%) patients, refractory hypertension 31 (12.1%) patients. The group of probably resistant hypertension 6 (2.3%) patients, probably refractory hypertension 9 (3.5%) patients. Of the 28 events that occurred, 6 were attributed to coronary artery disease (including 3 acute myocardial infarction and 2 coronary artery stenting), 3 strokes, 6 episodes of transient ischemic attack and 10 new cases of atrial fibrillation, and 2 patients had sudden cardiac death. Significantly more often, patients with refractory hypertension developed any event compared with patients with controlled (38.7% versus 3.4%; p=0.005) and resistant hypertension (38.7% versus 13.6%; p=0.04). Also, patients from the group of probably refractory hypertension were more likely to develop events than patients with controlled hypertension (33.3% versus 3.4%; p=0.045). Patients with probably refractory hypertension significantly more often had a stroke than patients with controlled hypertension (22.2% versus 0%; p0.05), and patients with refractory hypertension significantly more often had a transient ischemic attack compared with patients from the group of controlled hypertension (12.9% versus 0.7%; p=0.03). Conclusion. Patients with refractory and probably refractory hypertension are significantly more likely to develop cardiovascular and cerebrovascular complications than patients with controlled hypertension.
Patients with arterial hypertension represent a special population group with a high risk of developing cardiovascular diseases. The most difficult to control are resistant and refractory hypertension. It is known that patients with uncontrolled hypertension have a worse prognosis, both in terms of cardiovascular events and all-cause mortality. This review presents topical issues related to the features of pathogenesis, treatment and prognosis in patients with refractory and refractory hypertension.
This paper presents state of the art of the problem of diagnosis and treatment of orthostatic hypotension (OH). It focuses on the developed algorithms for diagnostics of classical orthostatic hypotension (COH), initial orthostatic hypotension (IOH) and delayed orthostatic hypotension (DOH). It describes the necessary methods for the differential diagnosis of the OH causes. Comparative analysis of the European Society of Cardiology and American College of Cardiology/American Heart Association/Society of Cardiac Rhythm was performed. The treatment options for different groups of patients with orthostatic hypotension are described.
Aim.The aim of our study was to assess the prevalence of contrast-induced acute kidney injury (CI-AKI) in patients with stable coronary artery disease (CAD) receiving optimal medical treatment with indications to coronary angiography and intraarterial administration of contrast agents. Materials and methods.1023 patients with stable CAD were included in the open prospective observational cohort study. The CI-AKI was defined as a rise in serum creatinine 25% from baseline. The mean age of the study group was 61.710.1 years; 72.4% were males and 84.4% had arterial hypertension. A multiple logistic regression model of prediction of CI-AKI was created. Results.CI-AKI developed in 132 (12.9%) of the patients. The multiple logistic regression model included gender, BMI, weight, age, heart failure, diabetes mellitus, arterial hypertension, anemia, hyperuricemia, proteinuria and baseline serum creatinine. Area under the curve for the model was 0.749 (95% confidence interval 0.7030,795;p0.0001). When trying to build a prognostic model, including baseline GFR and contrast volume, the model lost significance and the AUC diminished. Conclusion.The CI-AKI remains quite a common kidney injury developing in patients with stable CAD undergoing percutaneous interventions. Several risk factors need to be assessed very carefully before any intervention requiring intraarterial contrast media administration especially in patients with comorbidities.
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