Refractory Hypertension: a Narrative Systematic Review with Emphasis on Prognosis

Bacan, Giovanna; Ribeiro-Silva, Angélica; Oliveira, Vinicius A.; Cardoso, Claudia R.L.; Salles, Gil F.

doi:10.1007/s11906-022-01165-w

Cited by 6 publications

(6 citation statements)

References 55 publications

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“…A recent review paper has summarized the worse prognosis of patients with RfHTN based on 2 large prospective studies [ 59 ]. The first study enrolled patients seen over 16 years in outpatient clinics in a university hospital in Brazil [ 60 ].…”

Section: Discussionmentioning

confidence: 99%

An Update on Refractory Hypertension

et al. 2022

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Purpose of Review To update on definition, diagnosis, prevalence, patient characteristics, pathophysiology, and treatment of refractory hypertension (RfHTN). Recent Findings Refractory hypertension (RfHTN) is defined as blood pressure (BP) that is uncontrolled despite using ≥ 5 antihypertensive medications of different classes, including a long-acting thiazide diuretic and a mineralocorticoid receptor antagonist (MRA) at maximal or maximally tolerated doses. This new phenotype is different from resistant hypertension (RHTN), defined as BP that is uncontrolled despite using ≥ 3 medications, commonly a long-acting calcium channel blocker (CCB), a blocker of the renin-angiotensin system (angiotensin-converting enzyme [ACE] inhibitor or angiotensin receptor blocker [ARB]), and a diuretic. The RHTN phenotype includes controlled RHTN, BP that is controlled on 4 or more medications. RfHTN is largely attributable to increased sympathetic activity, unlike RHTN, which is mainly due to increased intravascular fluid volume frequently caused by hyperaldosteronism and chronic excessive sodium ingestion. Compared to those with controlled RHTN, patients with RfHTN have a higher prevalence of target organ damage and do not have elevated aldosterone levels. Ongoing clinical trials are assessing the safety and efficacy of using devices to aid with BP control in patients with RfHTN. Summary RfHTN is a separate entity from RHTN and is generally attributable to increased sympathetic activity.

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Section: Discussionmentioning

confidence: 99%

An Update on Refractory Hypertension

et al. 2022

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“…Рефрактерная АГ (рфАГ) определяется как артериальное давление (АД), которое не контролируется, несмотря на прием ≥5 антигипертензивных препаратов различных классов, включая тиазидный диуретик длительного действия и антагонист минералокортикоидных рецепторов в максимальных или максимально переносимых дозах. Этот фенотип отличается от неконтролируемой резистентной АГ (РАГ), определяемой при отсутствии целевого уровня АД, несмотря на прием от 3 до 4 препаратов в максималь-ных или максимально переносимых дозах [2], более высоким риском сердечно-сосудистых осложнений [3,4]. При этом предполагается, что в основе рфАГ лежит симпатическая гиперактивация, тогда как для неконтролируемой РАГ в большей степени характерен объем-зависимый механизм повышения АД [5].…”

Section: Beta-adrenergic Reactivity Of Erythrocyte Membranes In Vario...unclassified

Beta-adrenergic reactivity of erythrocyte membranes in various phenotypes of uncontrolled hypertension

Manukyan,

Falkovskaya,

Mordovin

et al. 2024

Russ J Cardiol

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Aim. To assess the functional state of the sympathetic nervous system according to β-adrenergic reactivity of erythrocyte membranes (EM) in patients with refractory (rfHTN) and resistant hypertension (rHTN) in relation to target organ damage.Material and methods. The cross-sectional comparative study included 78 patients with uncontrolled hypertension (mean age, 57,4±9,3 years (33 men)) with 24-hour blood pressure (BP) (systolic/diastolic) of 160,0±18,8/88,1±17,3 mm Hg. Thirty-nine (50%) patients had type 2 diabetes (T2D). At baseline, patients were divided into 2 groups depending on the phenotype of uncontrolled hypertension. The first group consisted of patients with rfHTN (n=26 (33,3%)), the second — with rHTN (uncontrolled BP with 3-4 agent therapy) (n=52 (66,7%)). In all patients, office and mean 24-hour blood pressure, EM β-adrenergic reactivity and target organ damage were assessed.Results. The compared groups did not differ in sex and age composition, prevalence of T2D and basic clinical data. However, despite comparable levels of office and mean 24-hour blood pressure, the incidence of left ventricular (LV) hypertrophy according to echocardiography in rfHTN was significantly higher than in rHTN (96,2% vs 76,9%, p=0,027, respectively). An increase in EM β-adrenergic reactivity (>20 conventional units) was documented in 87,1% of patients in the general group. Moreover, the mean EM β-adrenergic reactivity in the rfHTN group was significantly higher than in the rHTN group (51,5±18,7 vs 39,3±18,2, p=0,008). According to ROC analysis, the threshold value of EM β-adrenergic reactivity corresponding to rfHTN was ≥44,8 conventional units (sensitivity — 69,2%, specificity — 64,5%, area under the ROC curve — 0,687). The mean EM β-adrenergic reactivity in the rfHTN group did not have a direct relationship with the LV mass index, but correlated with increased pulse pressure.Conclusion. RfHTN is associated with higher EM β-adrenergic reactivity values than in patients with rHTN, which may indirectly confirm more pronounced sympathetic activity and explain the higher prevalence of LVH, realized through an increase in vascular stiffness and load on the LV.

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“…Российский журнал персонализированной медицины. 2022;2 (5):62-71. DOI: 10.18705/2782-3806-2022-2-5-62-71.…”

Section: резюмеunclassified

“…Среди больных с неконтролируемой АГ, в среднем у 10-15 % диагностируется резистентная АГ (РАГ), которая в значительной степени повышает риск сердечно-сосудистых катастроф [4]. Наиболее неблагоприятной формой АГ считается рефрактерная АГ (РефАГ), распространенность которой не превышает 4,5 % среди всех лечащихся гипертензивных пациентов, но, согласно эпидемиологическим исследованиям, может составлять практически половину случаев РАГ [5]. Необходимо подчеркнуть, что значительная доля (~ 30-50 %) пациентов с предполагаемой РАГ (в число которых входят и пациенты с РефАГ) при углубленном анализе оказываются «псевдорезистентными», в основном из-за ошибок при офисных измерениях АД, феномена «белого халата», терапевтической инертности [4,6].…”

Section: Introductionunclassified

Directly observed therapy to assess adherence in patient with apparent refractory hypertension. A case-report

Ionov

Emelyanov

Конради

2022

jour

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Refractory arterial hypertension (RefHTN) is an extreme phenotype of resistant hypertension (RHTN), is associated with utmost poor clinical sequelae. True RHTN occurs in 10-15 % of treated patients. Up to half of them meet the definition of RefHTN, but another ~50 % are eventually diagnosed with ‘pseudo’-RHTN. Partial or complete non-adherence are among its the main causes. To date, there is no ‘gold’ standard to assess adherence. Directly observed therapy (DOT) is a promising non-invasive method to assess patient compliance. The wellknown abroad, DOT is not widely used in Russian clinical practice. In this short report we demonstrate a case of DOT in a patient with apparent RefHTN.

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Refractory Hypertension: a Narrative Systematic Review with Emphasis on Prognosis

Cited by 6 publications

References 55 publications

An Update on Refractory Hypertension

An Update on Refractory Hypertension

Beta-adrenergic reactivity of erythrocyte membranes in various phenotypes of uncontrolled hypertension

Directly observed therapy to assess adherence in patient with apparent refractory hypertension. A case-report

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