Prevalence and clinical profile of refractory hypertension in a large cohort of patients with resistant hypertension

Chedier, Bernardo; Cortez, Arthur Fernandes; Roderjan, Christian Nejm; Cavalcanti, André G.; Carlos, Fernanda Oliveira de Carvalho; Santos, Bruno Dussoni Moreira Dos; Muxfeldt, Elizabeth Silaid

doi:10.1038/s41371-020-00406-2

Cited by 7 publications

(5 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We observed a high prevalence of concomitant risk factors for CVD, including dyslipidemia (78%), diabetes mellitus (48%), and obesity (42%), as previously described in patients with RH. 10 However, we found a lower prevalence of current smoking (3%), probably reflecting sex differences in the prevalence of traditional cardiovascular risk factors. 11 In a previous study involving hypertensive patients followed in primary health care centers in Portugal (the PRECISE study), the prevalence of cardiovascular comorbidities in women was similar to that found in our sample, especially for dyslipidemia, current smoking, and obesity, in addition to similar rates of uncontrolled hypertension.…”

Section: Discussionmentioning

confidence: 51%

Clinical Characteristics and Therapeutic Adherence of Women in a Referral Outpatient Clinic for Severe Hypertension

Barletta¹,

Magalhães²,

Almeida³

et al. 2021

International Journal of Cardiovascular Sciences

View full text Add to dashboard Cite

Cardiovascular disease (CVD) is the leading cause of death worldwide. For many years, it was believed that CVD was much more prevalent in men, probably due to the lack of studies that addressed this issue in women and their risk factors, according to their biological particularities. 1 Cardiovascular risk factors common to both genders have been identified. However, some studies have shown that these factors are associated with worse outcomes in women in comparison to men. [2][3][4] In general, women usually develop CVD 10 years later than men, so that the prevalence of CVD increases in the postmenopausal period, probably due to the decline in estrogen hormone levels. 5

show abstract

Section: Discussionmentioning

confidence: 51%

Clinical Characteristics and Therapeutic Adherence of Women in a Referral Outpatient Clinic for Severe Hypertension

Barletta¹,

Magalhães²,

Almeida³

et al. 2021

International Journal of Cardiovascular Sciences

View full text Add to dashboard Cite

show abstract

“…In agreement with our findings, an association between stroke and RfH has been reported in a prospective cohort with a hazard ratio of 2.03 (1.15 to 3.60) compared to patients with RH; 12 other cross-sectional studies also demonstrate this association. 11,16 A higher prevalence of RfH among stroke survivors has also been reported in a cross-sectional study, which found an association between RfH and stroke subtypes that arise from small arteries disease, such as intracerebral hemorrhages and lacunar infarcts. 23 The association between these events and RfH may reflect pathophysiological differences between these severe hypertension phenotypes.…”

Section: Acei Angiotensin-converting Enzyme Inhibitors; Arb Angiotens...mentioning

confidence: 69%

“…We observed a high prevalence of RfH among patients with RH in our study (20.4%), above the values found in other studies, which varied between 10.6% and 13.9%. 11,12 These differences can be explained by the clinical profile of the population, as the study was carried out in an outpatient referral clinic for severe hypertension, in addition to the large number of Black and multiracial patients, which have been reported as associated with severe hypertension phenotypes. 16,17 Divergences between studies commonly arise due to methodological differences, which reflect the challenges in excluding patients with pseudo-resistance.…”

Section: Discussionmentioning

confidence: 99%

“…15 among the population with RH is estimated to be between 3% and 15%. 5,[9][10][11][12] The high variance is mainly due to differences between methodologies. The prognosis of refractory patients has been described as worse than those of resistant patients, with a higher frequency of target organ damage secondary to adverse cardiovascular events, such as stroke.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Stroke Is Associated with Refractory Hypertension among Resistant and Refractory Patients in a Cross-Sectional Study

Costa¹,

Oliveira‐Filho²,

Ferreira-Campos³

et al. 2023

International Journal of Cardiovascular Sciences

View full text Add to dashboard Cite

Hypertension is an important risk factor for adverse cardiovascular events, including stroke. Achieving blood pressure (BP) control, therefore, is an essential step to reduce the impact the condition has on patients' health. However, it is estimated that only 10% of patients with hypertension reach their BP goal. Resistant hypertension (RH) is a phenotype of hypertension characterized by high risk and difficulty in achieving BP goal. 1 It is defined as uncontrolled BP despite the use of 3 or more antihypertensive drugs in adequate doses, including a diuretic, a calcium channel blocker, and a reninangiotensin system blocker, or controlled BP with the use of 4 or more medications. 2,3 This classification allows the identification of patients who share clinical and epidemiological characteristics and who can benefit from specific strategies. 4,5 It is estimated that 11.7% to 13.7% of all patients with hypertension have RH. [6][7][8] Refractory hypertension (RfH) is a severe subtype of RH and is defined as uncontrolled BP despite the use of 5 or more antihypertensive drugs, including spironolactone and a thiazide-like diuretic. 2,3 The prevalence of RfH

show abstract

“…A growing body of literature has described different epidemiological, pathophysiological, and clinical characteristics in these two entities, showing that patients with RfHT are younger and more obese [24,25], with a higher prevalence of metabolic syndrome, diabetes mellitus, asymptomatic organ damage as LVH [26], chronic kidney disease stage 3 with/without albuminuria [6], and established cardiovascular diseases such as stroke [6,25,27] and heart failure [24,27].…”

Section: Obstructive Sleep Apnea-associated Factors In Refractory Hyp...mentioning

confidence: 99%

Prevalence and associated factors of obstructive sleep apnea in refractory hypertension

Chedier

Roderjan

Cavalcanti

et al. 2022

Journal of Hypertension

Self Cite

View full text Add to dashboard Cite

Background:Refractory hypertension (RfHT) and obstructive sleep apnea (OSA) share common pathophysiological mechanisms and probably are intrinsically associated, but their prevalence, clinical profile, and polysomnography (PSG) pattern remain misunderstood.Objective:To describe OSA prevalence and PSG pattern of patients with RfHT in a large cohort of resistant hypertension (RHT).Methods:This is a cross-sectional study involving 418 RHT patients (30.9% male; mean age of 62.5 ± 9.9 years) who were submitted to full-night PSG. RfHT was defined as uncontrolled ambulatory blood pressure monitoring using five or more antihypertensive drugs, including spironolactone. Bivariate analysis compared RHT and RfHT and multivariate analysis was performed to assess the independent correlates of OSA.Results:A total of 90 patients (21.5%) were diagnosed with RfHT (26.7% male; mean age of 58.5 ± 8.3 years). In comparison with resistant ones, RfHT patients were younger, with higher smoking and previous cardiovascular diseases prevalence, especially stroke. There was no difference regarding anthropometric measures. OSA prevalence (80.0 vs. 82.9%) and moderate/severe OSA (51.1 vs. 57.0%) were similar in both groups as well as apnea–hypopnea index. In its turn, refractory hypertensive patients presented better sleep efficiency (78 vs. 71%), with higher total sleep time (315 vs. 281 min) and lower sleep latency (11 vs. 17 min). There was no difference regarding rapid eye movement sleep, oxygen saturation, microarousals index, and periodic limb movement.Conclusion:In this large RHT cohort, resistant and refractory hypertensive patients have similar OSA prevalence, although refractory ones, which by definition use spironolactone, are younger and apparently have a better sleep pattern.

show abstract

Prevalence and clinical profile of refractory hypertension in a large cohort of patients with resistant hypertension

Cited by 7 publications

References 30 publications

Clinical Characteristics and Therapeutic Adherence of Women in a Referral Outpatient Clinic for Severe Hypertension

Clinical Characteristics and Therapeutic Adherence of Women in a Referral Outpatient Clinic for Severe Hypertension

Stroke Is Associated with Refractory Hypertension among Resistant and Refractory Patients in a Cross-Sectional Study

Prevalence and associated factors of obstructive sleep apnea in refractory hypertension

Contact Info

Product

Resources

About