Phenotypic Characteristics of Resistant Hypertension in the Brazilian Population

Abstract

Resistant hypertension (RH) is defined as blood pressure that remains above target in spite of the concurrent use of three or more classes of antihypertensive drugs at optimized doses (UCRH), with one of them being a diuretic. Moreover, patients whose blood pressure is controlled while using four or more antihypertensive medications are also considered controlled resistant hypertensive (CRH) subjects. Although this definition may be useful in terms of categorizing a larger group of resistant hypertensive individuals, as these two subgroups share high cardiovascular risk, some important clinical and pathophysiologic particularities need to be better evaluated, before considering resistant controlled and uncontrolled patients as part of the same group. We compared cardiovascular characteristics of these two subgroups with resistant hypertension. In spite of some similar features, the UCRH subgroup has cardiovascular phenotypes with worse prognosis, such as increased vascular stiffness and left ventricular hypertrophy, as well as more impaired endothelial function and lower nocturnal blood pressure dipping, among others. Considering these differences, the UCRH subgroup is associated with greater cardiovascular risk and may be considered as more resistant to antihypertensive treatment. In addition to the importance of better prevention and treatment of resistant hypertension by identifying early risk factors and optimizing drug therapy, some clinical implications must be considered when managing controlled and uncontrolled patients as similar to the resistant hypertension group.

Adiponectin ‐11377C/G and +276G/T Polymorphisms affect Adiponectin Levels but do not Modify Responsiveness to Therapy in Resistant Hypertension

“…Although we did not find differences in allele, genotype, neither in haplotype frequencies, those findings require special attention as recent studies raised evidence that some features are different among RHTN subgroups . Therefore, those aspects may have important implications because negative findings in clinical studies may be due to the inclusion of both controlled and uncontrolled individuals, which can decrease the chance of obtaining accurate associations between polymorphisms and RHTN .…”

Effects of PDE type 5 inhibitors on Left Ventricular Diastolic Dysfunction in Resistant Hypertension

“…Resistant hypertension (RHTN) is a multifactorial condition characterized by blood pressure (BP) levels above goal (140/90 mmHg) in spite of the concurrent use of three or more antihypertensive drugs of different classes or controlled BP with the use of four or more agents 1 . The overall prevalence is estimated from 15% to 18% of all hypertensive individuals in population-based studies 2 , 3 and frequently the increasing number of antihypertensive drugs used in the course of disease 1 , 4 is associated with with overweight or obesity and diabetes type 2; however, those conditions are not enough to primarily explain the individuals' physical limitations and cardiovascular complaints. In an echocardiography study, it was observed that 95% of RHTN and 72% of controlled hypertensive subjects had left ventricular diastolic dysfunction (LVDD) with preserved systolic function 5 .…”