Cardiovascular and Renal Complications in Patients with Resistant Hypertension

Abstract

With an increased prevalence, resistant hypertension is recognized as an entity with a high cardiovascular morbidity and mortality. In a large cohort of patients with resistant hypertension, the crude incidence rate of total cardiovascular events reached 4.32 per 100 patient-years of follow-up (19.6 %), with a cardiovascular mortality of 8.3 % (incidence rate of 1.72 per 100 patient-years). Cardiovascular event rates are significantly higher in resistant hypertensives compared with non-resistant (18.0 % versus 13.5 %). In the same way, the prevalence of established cardiovascular and renal disease, as the asymptomatic organ damage (represented by left ventricular hypertrophy, carotid wall thickening, arterial stiffness, and microalbuminuria) is higher in these patients. Many studies have demonstrated a strong association between damage to these organs with higher blood pressure levels, the diagnosis of true resistant hypertension, and refractory hypertension. All efforts should be employed in order to control blood pressure and also to regress and/or prevent subclinical cardiovascular and renal damage. The focus should be on prevention of cardiovascular and renal complications, improving the prognosis of resistant hypertension.

Global- and Renal-Specific Sympathoinhibition in Aldosterone Hypertension

“…39 In the context of this analysis, it is important to note that the current findings and those from most clinical studies using device-based therapy have been limited to subjects with little or no impairment in renal function. However, because the presence of chronic kidney disease is a strong predictor of resistant hypertension and is a risk marker for increased cardiovascular morbidity and mortality in resistant hypertension, 6,40 future clinical trials are needed to explore the safety and efficacy of device-based therapies in this patient population with reduced renal function. Because the adverse effects of aldosterone antagonists, including worsening renal function and hyperkalemia, 11,13–14 may preclude their clinical use as antihypertensive agents in subjects with resistant hypertension and impaired renal function, the present findings suggest that the efficacy of device-based therapy may be limited under conditions when resistant hypertension is associated with aldosteronism and reduced GFR, but this hypothesis remains to be tested.…”

Impact of antibiotics on arterial blood pressure in a patient with resistant hypertension — A case report

“…An estimated 20–30% of hypertensive patients have resistant HTN (rHTN), defined as blood pressure (BP) ≥ 140/90 mm Hg on ≥3 antihypertensive drugs of different classes including one diuretic at optimal doses, or <140/90 on ≥4 drugs [1]. Patients with rHTN have increased risk for cardiovascular events (e.g., coronary artery disease, stroke, and heart failure) [1].…”

“…An estimated 20–30% of hypertensive patients have resistant HTN (rHTN), defined as blood pressure (BP) ≥ 140/90 mm Hg on ≥3 antihypertensive drugs of different classes including one diuretic at optimal doses, or <140/90 on ≥4 drugs [1]. Patients with rHTN have increased risk for cardiovascular events (e.g., coronary artery disease, stroke, and heart failure) [1]. New antihypertensive drugs and interventional procedures (e.g., renal sympathetic denervation, immunization against angiotensin II, and baroreflex activation) have been extensively studied to address the unmet need of controlling BP in this patient population; however, rHTN remains a challenging task for healthcare providers.…”

Target Organ Damage And The Long Term Effect of Nonadherence To Clinical Practice Guidelines In Patients With Hypertension: A Retrospective Cohort Study

“…Complications declined 1 to 3 years after diagnosis due to the initiation of therapy and life style modifications [20]. But after five years the complication became common again; this might be due to the fact that the therapy is overcome due to the progression of the disease in resistance to HTN and aging of the patients [21,22]. The cumulative incidence of HF was 30.8% which was relatively higher rate as compared to a finding reported by Sahle et al 6.26/1000/year [23].…”