Refractory versus resistant hypertension

Siddiqui, Mohammed; Calhoun, David A.

doi:10.1097/mnh.0000000000000286

Cited by 28 publications

(21 citation statements)

References 29 publications

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“…Similar findings have been described in other studies. 14,15,27 These data are probably associated with the possible mechanisms involved in the pathophysiology of RfH, attributing to this group of individuals characteristics that imply in the earlier development and greater severity of SAH.…”

Section: Discussionmentioning

confidence: 94%

“…14 Some studies point to an apparent worse prognosis, higher prevalence of injury to target organs and increased risk of cardiovascular events in patients with RH when compared to patients with non-resistant hypertension. 6,15,16 In black individuals, hypertension tends to manifest itself more severely, presenting greater difficulty in control and greater probability of complications and damage to target organs. 17 There is, however, a gap in the literature in the evaluation of the association between RH and individuals of African descent, 18 which can be attributed to genetic, environmental or even local factors.…”

Section: Introductionmentioning

confidence: 99%

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Características Clínicas da Hipertensão Arterial Resistente vs. Refratária em uma População de Hipertensos Afrodescendentes

Macedo

Aras

Macêdo

2020

Arquivos Brasileiros De Cardiologia

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Background: Afrodescendants have been associated with a greater severity of arterial hypertension and a higher incidence of cardiovascular complications. Characteristics in the presentation of resistant hypertension (RH) or refractory hypertension (RfH), specifically in this ethnic group, have not been properly studied. Objectives: The study compares clinical and epidemiological characteristics and prevalence of cardiovascular events in people of African descent diagnosed with RH or RfH. Methods: Cross-sectional study carried out in a referral clinic for patients with severe hypertension. The level of significance was 5%. Results: 146 consecutive patients were evaluated, of which 68.7% were female. The average age was 61.8 years, with 88.4% of Afrodescendants (mixed race or black). 51% had RfH. There was a high prevalence of cardiovascular risk factors: 34.2% of subjects had diabetes, 69.4% dyslipidemia, 36.1% obesity, and 38.3% history of smoking. Reduced renal function was seen in 34.2%. Previous cardiovascular events occurred in 21.8% for myocardial infarction and in 19.9% for stroke. The Framingham's risk score was moderate/high at 61%. RfH patients were younger (mean age 59.38±11.69 years versus 64.10±12.23 years, p=0.02), had more dyslipidemia (83.8 versus 66.7%, p=0.021), and stroke (30.4 versus 12.3%, p=0.011) when compared to those with RH. The use of a combination of ACEi/ARB+CCB+Diuretic, chlortalidone and spironolactone was also more frequent in individuals with RfH. Conclusion: Africandescendant people with RH had a high cardiovascular risk, a high prevalence of RfH, a higher frequency of dyslipidemia and stroke, compatible with a high incidence of injury to target organs.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Características Clínicas da Hipertensão Arterial Resistente vs. Refratária em uma População de Hipertensos Afrodescendentes

Macedo

Aras

Macêdo

2020

Arquivos Brasileiros De Cardiologia

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“…This novel type of uncontrolled hypertension seems to be rare, affecting less than 5% of the patients referred to a specialized clinic for uncontrolled hypertension. Furthermore, refractory hypertension was found to be more frequent in African-American, younger, and female patients [60][61][62] . There is evidence suggesting that the cause of treatment failure in patients with refractory hypertension, in contrast to resistant hypertension, is the increased sympathetic tone, rather than fluid retention, as indicated by the increased heart rate levels and urine norepinephrine excretion in such patients [60][61][62] .…”

Section: Refractory Hypertensionmentioning

confidence: 99%

“…Furthermore, refractory hypertension was found to be more frequent in African-American, younger, and female patients [60][61][62] . There is evidence suggesting that the cause of treatment failure in patients with refractory hypertension, in contrast to resistant hypertension, is the increased sympathetic tone, rather than fluid retention, as indicated by the increased heart rate levels and urine norepinephrine excretion in such patients [60][61][62] . Therefore, intensification of diuretic therapy may not be effective, and sympatholytic agents or device-based therapy may be preferable [60][61][62] .…”

Section: Refractory Hypertensionmentioning

confidence: 99%

“…There is evidence suggesting that the cause of treatment failure in patients with refractory hypertension, in contrast to resistant hypertension, is the increased sympathetic tone, rather than fluid retention, as indicated by the increased heart rate levels and urine norepinephrine excretion in such patients [60][61][62] . Therefore, intensification of diuretic therapy may not be effective, and sympatholytic agents or device-based therapy may be preferable [60][61][62] . However, data in such patients are still missing and studies are needed to identify optimal management options.…”

Section: Refractory Hypertensionmentioning

confidence: 99%

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Recent advances in understanding and managing resistant/refractory hypertension

et al. 2020

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The management of resistant hypertension presents several challenges in everyday clinical practice. During the past few years, several studies have been performed to identify efficient and safe pharmacological and non-pharmacological options for the management of such patients. The Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2) trial demonstrated significant benefits with the use of spinorolactone as a fourth-line drug for the treatment of resistant hypertension over doxazosin and bisoprolol. In addition, recent data support that spironolactone may demonstrate superiority over central acting drugs in such patients, as well. Based on the European guidelines, spironolactone is recommended as the fourth-line drug option, followed by amiloride, other diuretics, doxazosin, bisoprolol or clonidine. Among several device-based approaches, renal sympathetic denervation had fallen into hibernation after the disappointing results of the Renal Denervation in Patients With Uncontrolled Hypertension (SYMPLICITY HTN) 3 trial. However, the technique re-emerged at the epicenter of the clinical and research interest after the favorable results of three sham-controlled studies, which facilitated novel catheters and techniques to perform the denervation. Significant results of iliac anastomosis on blood pressure levels have also been demonstrated. Nevertheless, the technique-related adverse events resulted in withdrawal of this interventional approach. Last, the sympatholytic properties of the carotid baroreceptor activation therapy were associated with significant blood pressure reductions in patients with resistant hypertension, which need to be verified in larger controlled trials. Currently device-based approaches are recommended only in the setting of clinical trials until more safety and efficacy data become available.

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Therapieresistente und -refraktäre arterielle Hypertonie

Wallbach

Koziolek

2018

Internist

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Therapy-resistant and therapy-refractory arterial hypertension differ in prevalence, pathogenesis, prognosis and therapy. In both cases, a structured approach is required, with the exclusion of pseudoresistance and, subsequently, secondary hypertension. Resistant hypertension has been reported to be more responsive to intensified diuretic therapy, whereas refractory hypertension is presumed to require sympathoinhibitory therapy. Once the general measures and the drug-based step-up therapy have been exhausted, interventional procedures are available.

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Refractory versus resistant hypertension

Cited by 28 publications

References 29 publications

Características Clínicas da Hipertensão Arterial Resistente vs. Refratária em uma População de Hipertensos Afrodescendentes

Características Clínicas da Hipertensão Arterial Resistente vs. Refratária em uma População de Hipertensos Afrodescendentes

Recent advances in understanding and managing resistant/refractory hypertension

Therapieresistente und -refraktäre arterielle Hypertonie

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