Posicionamento Brasileiro sobre Hipertensão Arterial Resistente – 2020

Júnior, Heitor Moreno; Gus, Miguel; Rosito, Guido Bernardo Aranha; Scala, Luiz César Nazário; Muxfeldt, Elizabeth Silaid; Alessi, Alexandre; Brandão, Andréa Araújo; Filho, Osni Moreira; Feitosa, Audes Diógenes de Magalhães; Júnior, O Passarelli; Souza, Dilma do Socorro Moraes de; Amodeo, Celso; Barroso, Weimar Kunz Sebba; Gomes, Marco Antônio Mota; Paiva, Annelise Machado Gomes de; Barbosa, Eduardo; Miranda, Roberto Dischinger; Vilela-Martin, José Fernando; Júnior, Wilson Nadruz; Rodrigues, Cibele Isaac Saad; Drager, Luciano F.; Bortolotto, Luiz Aparecido; Consolim‐Colombo, Fernanda Marciano; Sousa, Márcio Gonçalves de; Borelli, Flávio; Kaiser, Sérgio; Salles, Gil F.; Azevedo, Maria de Fátima de; Magalhães, Lucélia Batista Neves Cunha; Póvoa, Rui; Malachias, Marcus Vinícius Bolivar; Nogueira, Armando da Rocha; Jardim, Paulo César Brandão Veiga; Jardim, Thiago de Souza Veiga

doi:10.36660/abc.20200198

Cited by 21 publications

(38 citation statements)

References 168 publications

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“…24,25 Moreover, ABPM is important in performing therapeutic adjustment, detecting nondipper patterns (prognostic marker in RH), and introducing nightly doses of antihypertensive drugs (chronotherapy) to reverse the adverse pattern of nocturnal dipping. 5,6,[25][26][27] All these situations highlight the need to request ABPM or home BPM for individuals suspected of RH.…”

Section: Discussionmentioning

confidence: 99%

“…Four weeks prior to investigation for hyperaldosteronism, her thiazide diuretic, renin-angiotensin system blocker, and mineralocorticoidreceptor antagonist were stopped for screening this condition, in accordance with guidelines. [4][5][6] During outpatient follow-up, hydrochlorothiazide was exchanged for chlorthalidone (25 mg/day), and nitrendipine (20 mg/day) was added to her antihypertensive treatment. Nevertheless, the patient had several BP elevations of up to 290/180 mmHg and a hospital admission with hypertensive encephalopathy, even with the use of valsartan (320 mg/day), chlortalidone (25 mg/day), nitrendipine (20 mg/day), methyldopa (1,500 mg/day), atenolol (100 mg/day), and spironolactone (150 mg/day).…”

Section: Case Reportmentioning

confidence: 99%

“…It is defined as BP remaining above the recommended targets with the use of three or more antihypertensives of different classes, including a renin-angiotensin system blocker (angiotensin-converting enzyme inhibitor) or angiotensin-receptor blocker), a long-acting calcium channel blocker, and a longacting thiazide diuretic, all at maximum recommended and tolerated doses, with appropriate frequency, dosage, and proven adherence by the patient. 5,6 RH individuals represent a group at higher risk of target-organ damage, cardiovascular morbidity, and mortality. In 2012, the Brazilian Society of Cardiology issued its first position on RH, which included recommendations for diagnosis, evaluation, and treatment.…”

Section: Introductionmentioning

confidence: 99%

“…7 Since then, a large number of studies on RH have improved our understanding of its pathogenesis, evaluation, and treatment, and new statements of position have been published. 5,6 Nevertheless, the real prevalence of RH remains still controversial, mainly because of the difficulty in identifying cases of "pseudoresistance". 8,9 For correct diagnosis of RH, it is necessary to rule out factors that may interfere with BP control, such as accuracy of BP measurement, white-coat effect, adherence to pharmacological and nonpharmacological treatment, inadequate therapeutic regimen, and therapeutic inertia, in addition to the use of medications that increase BP and causes of secondary hypertension.…”

Section: Introductionmentioning

confidence: 99%

“…8,9 For correct diagnosis of RH, it is necessary to rule out factors that may interfere with BP control, such as accuracy of BP measurement, white-coat effect, adherence to pharmacological and nonpharmacological treatment, inadequate therapeutic regimen, and therapeutic inertia, in addition to the use of medications that increase BP and causes of secondary hypertension. 5,6 As such, the first step in the correct diagnosis of true RH is to exclude these factors.Among them, pharmacological nonadherence is a well-known and highly prevalent behavioral cause of poor BP control. [10][11][12][13][14][15] Medication adherence is defined as the process by which patients take their medications as prescribed, and comprises three components: initiation, implementation, and discontinuation.…”

Section: Introductionmentioning

confidence: 99%

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Evidence of Nonadherence in Cases of Pseudoresistant Hypertension

Zanatta¹,

Cosenso-Martin²,

Lopes³

et al. 2021

IBPC

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Case Reportmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Evidence of Nonadherence in Cases of Pseudoresistant Hypertension

Zanatta¹,

Cosenso-Martin²,

Lopes³

et al. 2021

IBPC

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Obstructive sleep apnea and hypertension-mediated organ damage in nonresistant and resistant hypertension

et al. 2023

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Resistant hypertension: Prevalence and profile of patients followed in a university ambulatory

et al. 2021

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Background: Hypertension affects about 36 million Brazilians. It is estimated that 10%–20% of these have resistant hypertension. These patients are at an increased risk of early target organ damage, as well as cardiovascular and renal events. Objective: To estimate the prevalence of resistant hypertension in a specialized outpatient clinic, to describe the sociodemographic and clinical characteristics of these patients, and to identify possible factors associated with resistant hypertension. Methods: Data collection from medical records of hypertensive patients treated using oral antihypertensive drugs in optimized doses at a specialized university clinic from March 2014 to December 2014, after ethical approval statement. All patients were using appropriate antihypertensive drugs in optimized doses and assisted at a teaching-assistance clinic of internal medicine of the Bahiana School of Medicine and Public Health in Brazil. Results: A total of 104 patients were enrolled and 31.7% (n = 33) had criteria for resistant hypertension. Of the total participants, 75.7% were female and 54.8% were black or brown. The average age was 61.7 years (SD ± 10.1). In the resistant hypertension group, 63.6% had diabetes, compared to 32.4% in the hypertension group. Among resistant hypertensive patients, 51.5% had dyslipidemia. Regarding drug treatment, 75.8% of the resistant hypertension group and 51.4% of the hypertension group used statins. Among patients with resistant hypertension, 90.9% used angiotensin II receptor blockers and 66.7%, dihydropyridine calcium channel blockers. In the resistant hypertension group, 75.8% used beta-blockers, against 25.4% in the hypertension group. Conclusion: The prevalence of hypertension was higher than that described in the global literature, which may be associated with the high percentage of black and brown (“pardos”) patients in the population studied, and also because the study was performed in a specialized outpatient clinic.

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Posicionamento Brasileiro sobre Hipertensão Arterial Resistente – 2020

Cited by 21 publications

References 168 publications

Evidence of Nonadherence in Cases of Pseudoresistant Hypertension

Evidence of Nonadherence in Cases of Pseudoresistant Hypertension

Obstructive sleep apnea and hypertension-mediated organ damage in nonresistant and resistant hypertension

Resistant hypertension: Prevalence and profile of patients followed in a university ambulatory

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