Features of Metabolic and Hemodynamic Indicators in Obese Patients With Resistant Hypertension

Abstract

Objective: To establish the features of metabolic and hemodynamic parameters in obese patients with true and pseudo-resistant arterial hypertension (AH). Design and method: The study included 200 patients with AH grade II and obesity I-II classes (age 45–55 years). Patients were initially prescribed dual antihypertensive therapy (ACEI and CCB). Those patients who did not reach target blood pressure (BP) levels after 3 months on dual therapy were additionally assigned a third antihypertensive drug (indapamide). Of the 98 patients who were assigned triple therapy, 48 patients did not reach target BP levels: 27 patients had pseudo-resistant AH (due to low compliance with treatment and insufficient adherence to the physician's instructions to ensure adequate levels of physical activity), and 21 patients had true resistant AH (did not have target BP levels with triple antihypertensive therapy and sufficient physical activity). These patients were additionally prescribed spironolactone. The effectiveness of the treatment in all groups was evaluated 6 months after the start of antihypertensive therapy. Results: Comparative assessment of obese patients in the presence and absence of resistant AH after 6 months of therapy showed that, unlike patients without resistance, individuals with resistant AH differed more pronounced cardiovascular remodeling and metabolic disorders, greater dysbalance of oxidative stress-antioxidant protection, greater proinflammatory activity and higher activity of the RAAS. When performing a comparative evaluation of the indicators in patients with pseudo-resistant and true resistant AH, it was found that patients with true resistance differed from pseudo-resistant patients with significantly lower (p = 0.0229) body mass index (BMI). In addition, in the absence of differences in BP levels, cardiovascular remodeling, lipid and carbohydrate profiles, patients with true resistance had significantly higher levels of aldosterone (p = 0.0449), higher activity of oxidative stress system (malondialdehyde, p = 0.0055 and diene conjugates, p = 0.0299), lower levels of general antioxidant protection (p = 0.0004), higher adiponectin levels (p = 0.0000), and lower leptin level (p = 0.0001), compared to pseudo-resistant patients Conclusions: Obese patients with true resistance differed from pseudo-resistant patients with significantly lower BMI, higher aldosterone level, higher activity of the oxidative stress system, lower activity of the antioxidant protection system, higher adiponectin level, and lower leptin level.