Clinical differences between resistant hypertensives and patients treated and controlled with three or less drugs
Abstract
BACKGROUND AND AIM: Clinical characteristics of resistant hypertensive patients in comparison to controlled patients have not been fully investigated in large cohorts. The aim of the study was to evaluate clinical differences, target organ damage and ambulatory blood pressure monitoring in resistant hypertensive patients and patients controlled on three or less drugs. METHODS: In December 2010, from the Spanish Ambulatory Blood Pressure Monitoring Registry, we identified 14 461 patients fulfilling criteria of resistant hypertension and 13 436 hypertensive patients controlled on three or less drugs. Clinical characteristics were compared between these two groups. RESULTS: Compared to controlled patients, those having resistant hypertension were older, more obese and had longer hypertension duration. They also had more frequently diabetes, dyslipidemia, reduced renal function, microalbuminuria, left-ventricular hypertrophy and previous history of cardiovascular events. In multivariate analyses, hypertension duration, obesity, abdominal obesity, left-ventricular hypertrophy, reduced estimated glomerular filtration rate, and microalbuminuria were independently associated with resistant hypertension. Resistant hypertensive patients had higher ambulatory blood pressures, but differences between office and ambulatory blood pressure (white-coat effect) were also more pronounced in this group, revealing a proportion of 40% of patients with normal 24-h blood pressure. On the contrary, values of 24-h blood pressure above 130 and/or 80 mmHg (masked hypertension) were present in 31% of apparently controlled patients. CONCLUSION: Resistant hypertension is associated with obesity, longer hypertension duration and kidney and cardiac damage. Ambulatory blood pressure monitoring reveals that white-coat hypertension is common among resistant hypertensive patients, as well as is masked hypertension among apparently controlled patients.
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In patients with resistant hypertension in the Spanish Ambulatory Blood Pressure Monitoring Registry, BMI ≥30 kg/m2 is an independent risk factor for resistant hypertension (odds ratio, 1.62; 95% CI, 1.32-1.99).
“In 14 461 patients with RH in the Spanish Ambulatory Blood Pressure Monitoring Registry, a BMI ≥30 kg/m2 was also an independent risk factor for RH (odds ratio, 1.62; 95% CI, 1.32–1.99).152”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [152]
Chronic renal insufficiency is a well-established cause of heightened salt sensitivity of blood pressure and has been repetitively linked to apparent treatment-resistant hypertension.
“Further indirect evidence can be derived from large population studies in which chronic renal insufficiency, a well-established cause of heightened salt sensitivity of BP, has been repetitively linked to aTRH.13,38,152”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [152]
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- Authors
- de la Sierra, A., Banegas, J. R., Oliveras, A., Gorostidi, M., Segura, J., de la Cruz, J. J., Armario, P., & Ruilope, L. M.
- Affiliations
- Universidad Autónoma de Madrid (ES)
- Hospital Del Mar (ES)
- Hospital Universitario Central de Asturias (ES)
- Hospital Universitario 12 De Octubre (ES)
- Venue
- Journal of Hypertension
- Published
- 2012-06
- Volume
- 30
- Issue
- 6
- Pages
- 1211-1216
- ISSN
- 0263-6352 (ISSN-L)
- OpenAlex
- W2005112083
- Cited by
- 147
- References
- 16
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 5 · 2023: 4 · 2022: 2 · 2021: 4 · 2020: 10 · 2019: 11 · 2018: 10 · 2017: 7 · 2016: 12 · 2015: 15 · 2014: 25 · 2013: 28 · 2012: 8
- FWCI
- 15.64
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Keywords
- resistant hypertension, ambulatory blood pressure monitoring, white coat hypertension, masked hypertension, target organ damage, left ventricular hypertrophy, microalbuminuria, obesity, duration of hypertension, estimated glomerular filtration rate, cardiovascular risk factors
- MeSH terms
- Aged, Antihypertensive Agents, Blood Pressure, Drug Therapy, Combination, Female, Humans, Hypertension, Male, Middle Aged
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