High Prevalence of Secondary Hypertension and Insulin Resistance in Patients with Refractory Hypertension

Abstract

These findings show that among normokalemic treatment-resistant hypertension, the presence of hyperaldosteronism and pheochromocytoma is quite high. Moreover, treatment resistance in hypertensive patients appears to be associated with insulin resistance.

Common Secondary Causes of Resistant Hypertension and Rational for Treatment

“…A somehow lower prevalence was found in the remaining two studies. A study from Spain reported a 14% prevalence of primary hyperaldosteronism in patients with refractory hypertension; however, patients with hypokalemia were excluded from the study suggesting that the true prevalence of primary aldosteronism could be up to two times higher than the one reported [141]. Finally, a similar prevalence of 14% has been reported in diabetic subjects with resistant hypertension [142].…”

Secondary Hypertension: Obesity and the Metabolic Syndrome

“…18 among 141 patients with resistant hypertension in another series, the average BMi was in the obese range (mean, 32 kg/m 2 ). 19 subgroups of patients with resistant hypertension who are also obese often have glucose intolerance and hyperinsulinemia 20 and require more intensive therapy, irrespective of BMi. 21 Obesity is linked to a higher rate of uncontrolled blood pressure and the use of larger doses of medication to achieve blood pressure control when compared with lean patients, even when adjusting for variables such as sex, age, and upper arm circumference.…”

“…the presence of obesity, insulin resistance and hyperinsulinemia may promote hypertension through diverse mechanisms, including vasoconstriction and vascular hypertrophy based on the progrowth effects of insulin, with abdominal adiposity predicting vascular endothelial dysfunction. 20,33 insulin resistance attenuates endothelial release of nitric oxide, a potent vasodilator, creating another potential hypertensive stimulus. 34 a recent study in a large national cohort showed that prehypertension was associated with insulin resistance.…”

Hypertension and hypertensive cardiomyopathy in patients with a relapse‐free history of phaeochromocytoma

“…Yet, overall only 0Á05-0Á1% of patients with sustained hypertension harbour phaeochromocytomas or paragangliomas (PCC/PGL), 1 but this number increases significantly in patients with treatment-resistant hypertension, where a prevalence of up to 4% has been reported. 2 In PCC/PGL patients identified during hormonal work-up of incidentalomas, about 87Á5% are hypertensive. 3 Obviously, in hypertensive PCC/PGL patients who lack typical paroxysms and, thus, are not diagnosed early, long-standing exposure to increased catecholamine levels and increased blood pressure (BP) can be assumed.…”

“…Echocardiographic measures were compared to healthy (n = 28) and hypertensive controls (n = 15). Results Median follow-up was 6 [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] years. Three patients had normal office and ambulatory BP and three patients had only increased office BP.…”