OR-56: Resistant hypertension revisited

• Published in: American journal of hypertension 2002-04, Vol.15 (S3), p.25A-25A
• Main Authors: Garg, Jay P., Folker, Amy C., Izhar, Munavvar, Elliott, William J., Black, Henry R.
• Format: Article
• Language: English
• Subjects: Antihypertensive Therapy; Hypertension Specialist; Resistant Hypertension
• ISSN: 0895-7061; 1941-7225; 1879-1905
• DOI: 10.1016/S0895-7061(02)02335-X

Resistant hypertension is a common reason for referral to specialized hypertension centers, despite increasing availability of many effective antihypertensive therapies. We reviewed the charts of 942 consecutive new patients seen from January, 1993 to November, 2001 and found 128 patients that met strict criteria for resistant hypertension: 1) physician referral for uncontrolled hypertension; 2) BP ≥ 140/90 mm Hg despite 3 antihypertensive drugs at appropriate doses; and 3) at least one follow-up visit. The baseline data of the selected cohort were: an average age of 54 ± 12 years, 46% male, and, on referral, an average SBP of 169 ± 19 mm Hg and an average DBP of 94 ± 13 mm Hg. After evaluation, the most common reasons for resistance were: drug-related causes (61%, including suboptimal medication regimens), nonadherence (13%), secondary causes of hypertension (7%), psychological causes (5%), office resistance (3%), and interfering substances (3%). Overall, following a variable period for changes to antihypertensive drug therapy, 56% of these patients had their blood pressure controlled to < 140/90 mm Hg at the most recent visit. This proportion is only slightly lower than the prevalence of controlled hypertension at the most recent visit in the entire Hypertension Center patient population (∼65%). BP control mainly resulted from regimen intensification, requiring on average 3.8 ± 0.9 antihypertensive medications. The most common changes included more: calcium-channel blockers (71% on referral, 84% at the last visit), diuretics (86% to 92%, mostly thiazide diuretics), ACE inhibitors (56% to 61%), and alpha-blockers (27% to 32%). Intensification of drug therapy also included uptitration in dose of existing prescriptions in the majority of cases. These data are strikingly similar to those of previous surveys of resistant hypertension from 1988 and 1998 and indicate that there is still an important role for the hypertension specialist in the diagnostic evaluation of resistant hypertension and conversion of uncontrolled BP to controlled BP.