Refractory Hypertension

Dudenbostel, Tanja; Siddiqui, Mohammed; Oparil, Suzanne; Calhoun, David A.

doi:10.1161/hypertensionaha.116.06587

Cited by 64 publications

(38 citation statements)

References 37 publications

(79 reference statements)

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“…In the present study, 7.9% of RH had RfH. Dudenbostel et al9, 17 reported that the prevalence of RfH in a referral hypertension unit was ≈5%, and Calhoun et al8 estimated a prevalence of RfH of 3.6% of subjects with controlled or uncontrolled RH. The slightly higher prevalence observed in our study could be explained by 2 reasons: first, because low BP control is one of the main indications for ABPM, it is possible that the Spanish Registry was selecting more subjects with difficult‐to‐treat hypertension than other population‐based studies.…”

Section: Discussionsupporting

confidence: 49%

“…Differences between RfH and RH go in the same direction as those observed when comparing RH versus controlled patients,4 thus suggesting that, when markedly present, the same characteristics leading to RH would be responsible for treatment failure and development of RfH, as an extreme phenotype 9…”

Section: Discussionmentioning

confidence: 74%

“…The slightly higher prevalence observed in our study could be explained by 2 reasons: first, because low BP control is one of the main indications for ABPM, it is possible that the Spanish Registry was selecting more subjects with difficult‐to‐treat hypertension than other population‐based studies. Secondly, the prevalence of RfH depends critically on the definition used, and thus our study may have overestimated the actual prevalence because in our definition we did not specifically require the mandatory use of chlorthalidone and spironolactone, which are associated with higher BP control rates 9. In fact, it is noteworthy that only 11% of our patients were treated with mineralocorticoid receptor antagonists.…”

Section: Discussionmentioning

confidence: 88%

“…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. As in RH, 24‐hour ambulatory blood pressure monitoring (ABPM) is of interest in RfH patients, considering that the magnitude of the white‐coat effect could also be involved in RfH.…”

mentioning

confidence: 99%

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Prevalence and Clinical Characteristics of Refractory Hypertension

Armario

Calhoun

Oliveras

et al. 2017

JAHA

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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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Section: Discussionsupporting

confidence: 49%

Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 88%

mentioning

confidence: 99%

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Prevalence and Clinical Characteristics of Refractory Hypertension

Armario

Calhoun

Oliveras

et al. 2017

JAHA

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“…This is defined as patients who have uncontrolled blood pressure despite being on ≥5 antihypertensive medications (usually on two diuretics) and under specialist care for their hypertension [58]. The prevalence is thought to be between 3 and 10% of patients referred with uncontrolled resistant hypertension to a specialist clinic [59, 60].…”

Section: When To Assess For Non-adherencementioning

confidence: 99%

How to Screen for Non-Adherence to Antihypertensive Therapy

et al. 2016

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The quality of assessment of non-adherence to treatment in hypertensive is poor. Within this review, we discuss the different methods used to assess adherence to blood-pressure-lowering medications in hypertension patients. Subjective reports such as physicians’ perceptions are inaccurate, and questionnaires completed by patients tend to overreport adherence and show a low diagnostic specificity. Indirect objective methods such as pharmacy database records can be useful, but they are limited by the robustness of the recorded data. Electronic medication monitoring devices are accurate but usually track adherence to only a single medication and can be expensive. Overall, the fundamental issue with indirect objective measures is that they do not fully confirm ingestion of antihypertensive medications. Detection of antihypertensive medications in body fluids using liquid chromatography–tandem mass spectrometry is currently, in our view, the most robust and clinically useful method to assess non-adherence to blood-pressure-lowering treatment. It is particularly helpful in patients presenting with resistant, refractory or uncontrolled hypertension despite the optimal therapy. We recommend using this diagnostic strategy to detect non-adherence alongside a no-blame approach tailoring support to address the perceptions (e.g. beliefs about the illness and treatment) and practicalities (e.g. capability and resources) influencing motivation and ability to adhere.

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International Consensus Statement on Obstructive Sleep Apnea

Chang

Goldberg

Alt

et al. 2023

Int Forum Allergy Rhinol

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Background: Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). Methods: Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidencebased review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. Results: The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. Conclusion:This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.

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Refractory Hypertension

Cited by 64 publications

References 37 publications

Prevalence and Clinical Characteristics of Refractory Hypertension

Prevalence and Clinical Characteristics of Refractory Hypertension

How to Screen for Non-Adherence to Antihypertensive Therapy

International Consensus Statement on Obstructive Sleep Apnea

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