Resistant hypertension in visceral obesity
Abstract
Background Visceral obesity increases the risk of arterial hypertension (78% of cases of hypertension in men and 65% of cases in women). The aim of the study is to assess the role of visceral obesity in causing resistant hypertension (RH).Methods The survey was performed on 5065 hypertensive patients with visceral obesity. BP control was analyzed on the basis of office and home BP measurements. Patients reporting non-compliance were excluded from the study.Results The percentage of RH after excluding undertreated patients (receiving less than 3 drugs or on at least 3-drug regimen without diuretic and without reaching target BP goal) was 13.9%. RH was more frequent only in obese with BMI ≥ 35 and <40 kg/m(2) (16.2%) and in morbidly obese individuals (26.5%). Patients with BMI ≥ 35 and <40 kg/m(2) and with morbid obesity were receiving three-drug therapy more frequently than patients with visceral obesity and BMI<30 kg/m(2). A multiple regression analysis revealed that obesity was associated with RH independent from longer than 5-year period of antihypertensive therapy, diabetes, smoking cigarettes, cardiovascular disease and heart failure. The analysis of home BP measurement revealed that in 11.1% of patients RH was in fact "white coat" hypertension.Conclusions Undertreatment, underuse of diuretics in multidrug regimens, and the "white-coat" effect are the most common reasons for over-diagnosing resistant hypertension in patients with visceral obesity. Obesity is an independent risk factor for the occurrence of RH.
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Obesity, left ventricular hypertrophy, albuminuria, diabetes mellitus, chronic kidney disease, higher Framingham 10-year risk score, and obstructive sleep apnea are more common in resistant hypertension than non-resistant hypertension.
“Obesity,39–41 left ventricular hypertrophy,42 albuminuria,14,43 diabetes mellitus,14,38,39 CKD,38,39,44 higher Framingham 10-year risk score,39 and obstructive sleep apnea (OSA)45,46 are more common in RH than non-RH.”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [41]
Suboptimal antihypertensive drug regimens substantively contribute to the likelihood of being diagnosed with resistant hypertension.
“Suboptimal antihypertensive drug regimens substantively contribute to the likelihood of being diagnosed with RH.41,60,61”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [41]
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- Authors
- Holecki, M., Duława, J., & Chudek, J.
- Affiliations
- Medical University of Silesia (PL)
- Corresponding author
- Holecki, Michał
- Venue
- European Journal of Internal Medicine
- Publisher
- Elsevier BV
- Published
- 2012-10
- Volume
- 23
- Issue
- 7
- Pages
- 643-648
- ISSN
- 0953-6205 (ISSN-L)
- OpenAlex
- W2023326473
- Cited by
- 44
- References
- 20
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 4 · 2023: 6 · 2021: 3 · 2020: 5 · 2019: 1 · 2018: 3 · 2016: 1 · 2015: 3 · 2014: 7 · 2013: 8
- FWCI
- 3.70
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Keywords
- resistant hypertension, visceral obesity, morbid obesity, body mass index, antihypertensive therapy, diuretics, undertreatment, white coat hypertension, home blood pressure monitoring, office blood pressure, hypertension risk factors
- MeSH terms
- Age Factors, Aged, Alcohol Drinking, Antihypertensive Agents, Diuretics, Drug Therapy, Combination, Female, Humans, Hypertension, Male, Middle Aged, Obesity, Morbid, Regression Analysis, Risk Factors, Sex Factors, Smoking, Body Mass Index, Obesity, Abdominal, White Coat Hypertension
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