Distinctive Risk Factors and Phenotype of Younger Patients With Resistant Hypertension

Abstract

Resistant hypertension, defined as blood pressure >140/90 mmHg despite using ≥3 antihypertensive medications, is a well-recognized clinical entity. Patients with resistant hypertension are at an increased risk of cardiovascular disease compared with those with more easily controlled hypertension. Coronary heart disease mortality rates of younger adults are stagnating or on the rise. The purpose of our study was to characterize the phenotype and risk factors of younger patients with resistant hypertension given the dearth of data on cardiovascular risk profile in this cohort. We conducted a cross sectional analysis with predefined age groups of a large, ethnically diverse cohort of 2170 patients referred to the Hypertension Clinic at the University of Alabama at Birmingham. 2068 patients met the inclusion criteria and were classified by age groups, i.e. ≤40 yrs (12.7 % of total cohort), 41–55 yrs (32.1%), 56–70 yrs (36.1%) and ≥71 yrs (19.1%). Patients ≤40 yrs of age compared with ≥71 yrs, had significantly earlier onset of HTN (24.7±7.4vs 55.0±14.1 yrs, p<0.0001), higher rates of obesity (53.4% vs 26.9%, p<0.0001), and significantly higher levels of plasma aldosterone (11.3±9.8 vs 8.9±7.4 ng/dl, p=0.005), plasma renin activity (4.9±10.2 vs 2.5±5.0 ng/ml/hr, p=0.001), and 24-hr urinary aldosterone (13.4±10.0 vs 8.2±6.2 μg/24hr, p<0.0001) and sodium excretion (195.9±92.0 vs 146.8±67.1 mEq/24hr, p<0.0001). Among patients with resistant hypertension, younger individuals have a distinct phenotype characterized by overlapping risk factors and comorbidities, including obesity, high aldosterone and high dietary sodium intake compared to elderly.

Natural selection and local adaptation of blood pressure regulation and their perspectives on precision medicine in hypertension

“…In other words, cataloguing genomic variations that cover diverse populations, especially the indigenous populations are crucial to ensure the success of personalized medicine.Identifying the intermediate phenotypes of HTN:The findings from GWAS imply that the pathophysiology of HTN is heterogeneous, thus in agreement with the postulations that multiple causative factors which interplay with different environment factors could have contributed to the elevation of BP in different populations. Therefore characterizing different intermediate phenotypes of HTN is crucial [7, 75–77]. Korner (2010) defined two major intermediate phenotypes of HTN – stress and salt-sensitive HTN and obesity related HTN, which could be further characterized by neural and non-neural mechanisms [75].…”

Disparity in Health Care Utilization by Income Level and Insurance Status at Gamping Muhammadiyah Hospital, Yogyakarta, Indonesia

“…In the health service use theory which also states that age is one of the predisposing or internal factors that influence a person's behavior to make use of health services. The older a person is, a person's immune system will decrease and at the age of the elderly the degree of disease experienced will be more severe, the tendency of the elderly will increasingly require health services to cure the disease (Ghazi et al, 2017).…”