Clinical characteristics of patients with resistant hypertension: the RESIST-POL study

Abstract

Recent studies indicate that resistant hypertension (RHTN) is present in about 12% of the treated hypertensive population. However, patients with true RHTN (confirmed out of the office) have not been widely studied. We prospectively studied 204 patients (123 male, 81 female, mean age 48.4 years, range 19-65 years) with truly RHTN (ambulatory daytime mean blood pressure >135/85 mm Hg). We evaluated the frequency of obstructive sleep apnea (OSA), renal artery stenosis (RAS), primary aldosteronism (PA) and other secondary forms of hypertension (HTN) and conditions. Mild, moderate and severe OSA were present in 55 (27.0%), 38 (18.6%) and 54 (26.5%) patients, respectively. Secondary forms of HTN were diagnosed in 49 patients (24.0%), the most frequent being PA (15.7%) and RAS (5.4%). Metabolic syndrome (MS) was present in 65.7% of patients. Excessive sodium excretion was evident in 33.3% of patients and depression in 36.8% patients. In patients with RHTN, OSA and MS were the most frequent conditions, frequently overlapping with each other and also with PA. Our data indicate that in the vast majority of patients with truly RHTN, at least one of three co-morbidities-OSA, MS and PA-is present. Other conditions, even though less frequent, should also be taken into the consideration.

Relationship between primary aldosteronism and obstructive sleep apnoea, metabolic abnormalities and cardiac structure in patients with resistant hypertension

“…The study was approved by the Ethics Committee of the National Institute of Cardiology, Warsaw and informed written consent was obtained from each patient [6].…”

“…PA also overlapped with MS and OSA [6]. Because the coexistence of PA and OSA in patients with resistant hypertension has been reported only by a few authors, we analysed the relationship between PA and OSA, metabolic abnormalities and cardiac structure in patients with true resistant hypertension enrolled in the RESIST-POL Study [6,11,12].…”

“…The association of obstructive sleep apnoea (OSA) in hypertension is particularly marked among patients with RHTN, with studies reporting an OSA prevalence of 80% to 85% in these patients [6,7]. As in other diseases resulting from hormonal disturbances, the nondipping pattern of blood pressure during the night has been reported as a feature of patients with OSA [8].…”

Diagnostics and treatment of resistant arterial hypertension

“…Much more rare causes include Cushing's syndrome, pheochromocytoma, hyperparathyroidism, coarctation of the aorta, intracranial tumours. Referral and specific treatment of these diseases can improve blood pressure control and long-term prognosis [2,4].…”

“…The development of true RAH is promoted by specific, potentially reversible causes of secondary hypertension, such as renal artery stenosis and pheochromocytoma. It is shown that primary aldosteronism is much more common in hypertension than in the general population, reaching 20% at the RAH [1,2,4].…”