Refractory Hypertension: Definition, Prevalence, and Patient Characteristics

Acelajado, Maria Czarina; Pisoni, Roberto; Dudenbostel, Tanja; Dell’Italia, Louis J.; Cartmill, F R; Zhang, Bin; Cofield, Stacey S.; Oparil, Suzanne; Calhoun, David A.

doi:10.1111/j.1751-7176.2011.00556.x

Cited by 170 publications

(161 citation statements)

References 15 publications

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“…Among individuals already taking antihypertensive drugs, an adjuvant alternative treatment can be considered if clinically appropriate (eg, rapid BP reduction is not urgently required and if BP is <20/10 mm Hg above goal) to help avoid adding further medications. Other reasonable candidates include individuals who have controlled hypertension seeking to step-down or stop existing drug therapy, 163 individuals with persistent BP elevations despite maximal medical therapy (ie, refractory hypertension), 164 and those who have exhausted viable pharmacological options because of multiple drug intolerances.…”

Section: Bp Management Algorithmmentioning

confidence: 99%

Beyond Medications and Diet: Alternative Approaches to Lowering Blood Pressure

Brook¹,

Appel²,

Rubenfire³

et al. 2013

Hypertension

482

310

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Abstract-Many antihypertensive medications and lifestyle changes are proven to reduce blood pressure. Over the past few decades, numerous additional modalities have been evaluated in regard to their potential blood pressure-lowering abilities. However, these nondietary, nondrug treatments, collectively called alternative approaches, have generally undergone fewer and less rigorous trials. This American Heart Association scientific statement aims to summarize the blood pressure-lowering efficacy of several alternative approaches and to provide a class of recommendation for their implementation in clinical practice based on the available level of evidence from the published literature. The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. Expert peer review of AHA Scientific Statements is conducted by the AHA Office of Science Operations. For more on AHA statements and guidelines development, visit http://my.americanheart.org/statements and select the "Policies and Development" link.

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Section: Bp Management Algorithmmentioning

confidence: 99%

Beyond Medications and Diet: Alternative Approaches to Lowering Blood Pressure

Brook¹,

Appel²,

Rubenfire³

et al. 2013

Hypertension

482

310

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“…17,18 Finally, the DOCA-salt rat is the original model in which we demonstrated the ability of chronic (one week) administration of 5-HT to reduce blood pressure. 11 In the present study, in addition to telemetric measures of blood pressure, we measured isometric contraction of the isolated artery from all rats.…”

mentioning

confidence: 99%

One-Month Serotonin Infusion Results in a Prolonged Fall in Blood Pressure in the Deoxycorticosterone Acetate (DOCA) Salt Hypertensive Rat

Davis

Szasz

Garver

et al. 2012

ACS Chem. Neurosci.

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A 7-day infusion of serotonin (5-hydroxytryptamine, 5-HT) causes a sustained fall in elevated blood pressure in the male deoxycorticosterone acetate (DOCA)-salt rat. As hypertension is a long-term disease, we presently test the hypothesis that a longer (30 day) 5-HT infusion could cause a sustained fall in blood pressure in the established hypertensive DOCA-salt rat. This time period (∼4 weeks) was also sufficient to test whether 5-HT could attenuate the development of DOCAsalt hypertension. 5-HT (25 μg/kg/min; sc) or vehicle (Veh) was delivered via osmotic pump to (1) established DOCA-salt rats for one month, (2) Sprague− Dawley rats prior to DOCA-salt administration for one month, and blood pressure and heart rate measured telemetrically. On the final day of 5-HT infusion, free platelet poor plasma 5-HT concentrations were significantly higher in 5-HT versus Veh-infused rats, and mean arterial pressure was significantly lower in 5-HT-infused (135 ± 4 mmHg vs Veh-infused 151 ± 7 mmHg) established DOCA-salt rats. By contrast, 5-HT-infusion did not prevent the development of DOCA-salt hypertension (144 ± 7 mmHg vs Veh = 156 ± 6 mmHg). Isometric contraction of aortic strips was measured, and neither the potency nor maximum contraction to the alpha adrenergic receptor agonist phenylephrine (PE) or 5-HT were modified by infusion of 5-HT (established or preventative infusion), and maximum aortic relaxation to acetylcholine (ACh) was modestly but not significantly enhanced (∼15% improvement). This study demonstrates 5-HT is capable of lowering blood pressure in established DOCA-salt hypertensive rats over the course of one month in a mechanism that does not significantly modify or is dependent on modified vascular responsiveness. This finding opens the possibility that elevation of 5-HT levels could be useful in the treatment of hypertension. KEYWORDS: 5-HT, blood pressure, vascular reactivity, hypertension H ypertension is characterized by an elevation in arterial pressure, increased vascular resistance, cardiac hypertrophy, increased sympathetic nervous system tone, and altered renal function. 1 Despite the myriad of deleterious changes, the etiology of essential hypertension remains largely unknown. Interestingly, several lines of evidence suggest an important association between 5-HT and hypertension.5-HT is a vasoactive amine synthesized primarily in the enterochromaffin cells of the gastrointestinal tract, and the raphe nucleus in the central nervous system. 2−4 Free plasma 5-HT in both human and animal models of hypertension are elevated compared to normotensive human and animal controls. 5,6 5-HT receptor antagonists (5-HT 2A receptor antagonist ketanserin, 5-HT 2B receptor antagonist LY272015) lower blood pressure in select animal models of hypertension but are ineffective in others. 7−9 The arteries of hypertensive animals are hyperresponsive to the constrictor effects of 5-HT, and selective 5-HT reuptake inhibitors elevate blood pressure. 8−10 Collectively, this evidence suggests that elevated le...

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“…The term refractory hypertension (RfH) has been recently proposed to define subjects who do not achieve BP control with 5 or more antihypertensive drugs 7, 8. Its prevalence has been reported to be around 3% of RH subjects, and it has been associated with male sex, black race, obesity, and a higher prevalence of cardiovascular and renal alterations 8, 9.…”

mentioning

confidence: 99%

Prevalence and Clinical Characteristics of Refractory Hypertension

Armario

Calhoun

Oliveras

et al. 2017

JAHA

Self Cite

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BackgroundWe aimed to estimate the prevalence of refractory hypertension (RfH) and to determine the clinical differences between these patients and resistant hypertensives (RH). Secondly, we assessed the prevalence of white‐coat RfH and clinical differences between true‐ and white‐coat RfH patients.Methods and ResultsThe present analysis was conducted on the Spanish Ambulatory Blood Pressure Monitoring Registry database containing 70 997 treated hypertensive patients. RH and RfH were defined by the presence of elevated office blood pressure (≥140 and/or 90 mm Hg) in patients treated with at least 3 (RH) and 5 (RfH) antihypertensive drugs. White‐coat RfH was defined by RfH with normal (<130/80 mm Hg) 24‐hour blood pressure. A total of 11.972 (16.9%) patients fulfilled the standard criteria of RH, and 955 (1.4%) were considered as having RfH. Compared with RH patients, those with RfH were younger, more frequently male, and after adjusting for age and sex, had increased prevalence of target organ damage, and previous cardiovascular disease. The prevalence of white coat RfH was lower than white‐coat RH (26.7% versus 37.1%, P<0.001). White‐coat RfH, in comparison with those with true RfH, showed a lower prevalence of both left ventricular hypertrophy (22% versus 29.7%; P=0.018) and microalbuminuria (28.3% versus 42.9%; P=0.047).ConclusionsThe prevalence of RfH was low and these patients had a greater cardiovascular risk profile compared with RH. One out of 4 patients with RfH have normal 24‐hour blood pressure and less target organ damage, thus indicating the important role of ambulatory blood pressure monitoring in guiding antihypertensive therapy in difficult‐to‐treat patients.

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Refractory Hypertension: Definition, Prevalence, and Patient Characteristics

Cited by 170 publications

References 15 publications

Beyond Medications and Diet: Alternative Approaches to Lowering Blood Pressure

Beyond Medications and Diet: Alternative Approaches to Lowering Blood Pressure

One-Month Serotonin Infusion Results in a Prolonged Fall in Blood Pressure in the Deoxycorticosterone Acetate (DOCA) Salt Hypertensive Rat

Prevalence and Clinical Characteristics of Refractory Hypertension

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