Objective: Resistant hypertension is defined as blood pressure that remains above therapeutic goal despite concurrent use of three antihypertensive agents (at full or maximum tolerated doses) of different classes, one of which is a diuretic. The prevalence of secondary causes of hypertension among patients with resistant hypertension is not exactly known. Design and method: We retrospectively analysed the hospital records of patients with resistant arterial hypertension, who underwent complete laboratory and imaging examinations to exclude the secondary etiology of arterial hypertension. Standard descriptive statistics were used for statistical evaluation. Results: Among the 600 patients with resistant hypertension, secondary etiology of hypertension was found in 160 (27,5%). The most frequent cause was primary aldosteronism in 93 cases (58% relatively), followed by renovascular hypertension (30 cases, 18.8%), renal parenchymal hypertension (25 cases, 15,6%). Less common causes were pheochromocytoma (3,1%), hyperreninism (3.1%), hypercortisolism (0,6%). Obstructive sleep apnoea has been found in 75 (12.5%) patients. Conclusion: Secondary etiology was much more frequent (27,5%) in our group of patients with resistant hypertension than in non-selected hypertensive population (5–15%). Conclusions: This work was supported by IGA_LF_2019_036, IGA_LF_2020_039

Objective:Secondary hypertension often presents as treatment-resistant hypertension. Patients with resistant hypertension therefore undergo an extensive workup to identify a potential secondary cause. We aimed to analyze whether it is necessary to screen all patients presenting with resistant arterial hypertension for all secondary causes of hypertension.Design and method:We retrospectively analysed the hospital records of patients with resistant arterial hypertension, who underwent complete laboratory and imaging examinations to exclude the secondary etiology of arterial hypertension. Standard descriptive statistics were used for statistical evaluation.Results:Among the 432 patients with resistant hypertension, secondary etiology of hypertension was found in 135 (31.1%). The most frequent cause was primary aldosteronism in 85 cases (63% relatively), followed by renovascular hypertension (15.6%), renal parenchymal hypertension (14.8%) and hyperreninism (3.7%). Obstructive sleep apnoea has been found in 14.7% patients. Less common causes were hypercortisolism (1.5%), pheochromocytoma (0.7%) and adrenogenital syndrome (0.7%). All patients with the last three rare causes presented with specific clinical symptoms (i.e. patient with pheochromocytoma was admitted for paroxysmal hypertension, adrenogenital syndrome was diagnosed in female patient with secondary male sex characteristics, patients with hypercortisolism had typical cushingoid signs).Conclusions:Secondary etiology was much more frequent (31%) in our group of patients with resistant hypertension than in non-selected hypertensive population (5–15%). We suggest that first line testing only for primary hyperaldosteronism and renovascular hypertension would be sufficient for patients with resistant hypertension without clinical clues suggestive of another particular secondary cause of hypertension.

Objective: Some patients with end-stage renal disease present with resistant or refractory arterial hypertension despite dialysis and use of multiple antihypertensive drugs. Renal artery embolization is a rarely used minimally invasive interventional procedure which may provide improved blood pressure (BP) control in chronic renal parenchymal disease by eliminating renal function while avoiding the morbidity and mortality of a nephrectomy. Design and method: A 44-year old white male with chronic glomerulonephritis and stage 5 chronic kidney disease undergoing regular dialysis treatment was referred for refractory arterial hypertension. Despite treatment by 7 antihypertensive drugs and good therapeutic adherence his office and ambulatory BP remained very high. Plasma renin was markedly elevated and CT angiography found diffuse atherosclerotic changes of renal arteries. Sequential catheter-based renal artery embolization with application of a tissue glue was indicated. Results: In September 2019, catheter based embolization of right renal artery was performed in analgosedation, followed by the embolization of the left renal artery two weeks later. Because of the rapid antihypertensive effect of the procedure, antihypertensive medications were reduced at the time of the left-sided procedure (from 9 to 6 defined daily doses). One month after the renal artery embolization, despite reduced medication, office BP decreased from baseline 170/106 mmHg by 57/22 mmHg. Mean 24-hour, day-time and night-time ambulatory BP was reduced by 15/11 mmHg, 14/11 and 34/15 mmHg, respectively. The patient reported prolonged flank pain lasting approximately one week after the embolization, which responded well to conventional analgesics. Conclusions: Renal artery embolization lead to a marked improvement of BP control in a patient with end-stage renal disease, refractory arterial hypertension and high plasma renin. Further studies are warranted to assess the efficacy and safety of renal artery embolization in such patients.

Objective: Resistant hypertension is defined as blood pressure that remains above therapeutic goal despite concurrent use of three antihypertensive agents (at full or maximum tolerated doses) of different classes, one of which is a diuretic. The prevalence of secondary hypertension among patients with resistant hypertension is not exactly known. Design and method: We retrospectively analysed the hospital records of patients with resistant arterial hypertension, who underwent complete laboratory and imaging examinations to exclude the secondary etiology of arterial hypertension. Standard descriptive statistics, Mann-Whitney U test and Fisher's exact test were used for statistical evaluation. Results: Among the 432 patients with resistant hypertension, secondary etiology of hypertension was found in 135 (31.1%). The most frequent cause was primary aldosteronism in 85 cases (63% relatively), followed by renovascular hypertension (21 cases, 15.6%), renal parenchymal hypertension (20 cases, 14.8%). Less common causes were hyperreninism (3.7%), hypercortisolism (1.5%), pheochromocytoma (0.7%) and adrenogenital syndrome (0.7%). Obstructive sleep apnoea has been found in 63 (14.7%) patients. Patients with secondary hypertension were more frequently male (70.4% vs. 52.2%, p < 0.001), had a higher left ventricular mass index (LVMI 119 vs. 106 g / m2, P = 0.037) and lower estimated glomerular filtration rate (69 vs. 75 ml/min/1.73m2, P = 0.009). Both groups did not differ in age, office blood pressure or albuminuria. Conclusions: Secondary etiology was much more frequent (31%) in our group of patients with resistant hypertension than in non-selected hypertensive population (5–15%). Patients with secondary hypertension had more advanced target organ damage. This work was supported by the grant UP - IGA_LF_2019_036 a IGA_LF_2019_035. This work was supported by the grant IGA_LF_2020_039

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