Features of hemodynamic and metabolic disorders in obese patients with resistant hypertension

Abstract

Background. The aim was to establish the features of hemodynamic and metabolic parameters in obese patients with true and pseudo-resistant arterial hypertension (AH). Material and methods. The study included 200 patients with uncontrolled AH and obesity. Patients were initially prescribed dual antihypertensive therapy. Those patients who did not reach target blood pressure (BP) levels after 3 months on dual therapy were additionally prescribed a third antihypertensive drug. Of the 98 patients who were assigned to triple therapy, 48 patients did not reach target BP (27 patients had pseudo-resistant and 21 patients had true resistant AH). These patients were additionally prescribed a fourth antihypertensive drug (spironolactone). The effectiveness of the treatment was evaluated 6 months after the start of antihypertensive therapy. Results. After 6 months of therapy, unlike patients without resistance, individuals with resistant AH had more pronounced cardiovascular remodeling and metabolic disorders, disbalance of oxidative stress-antioxidant protection, proinflammatory activity and higher activity of the renin-angiotensin-aldosterone system. Patients with true resistance differed from pseudo-resistant patients by having significantly lower body mass index (BMI); in the absence of differences in BP levels, cardiovascular remodeling, lipid and carbohydrate profiles, patients with true resistance had significantly higher levels of aldosterone, higher activity of oxidative stress system, lower levels of general antioxidant protection, higher adiponectin levels, and lower leptin level. Conclusions. Obese patients with true resistance differed from pseudo-resistant patients by having significantly lower BMI, higher aldosterone levels, more pronounced imbalance of the system of oxidative stress-antioxidant protection and less pronounced adipokine imbalance.

Different faces of resistant hypertension in obesity

“…4). It was found that, similar to the results of our previous study, obese patients with true resistance had significantly lower BMI (p < 0.05) and higher levels of aldosterone (p < 0.05) compared with pseudo-resistant patients [10]. At the same time, in this work, new data were obtained on the difference in the levels of SBP (significantly higher with true resistance) and LDL-C (significantly lower with true resistance), which was not obtained with a smaller sample of patients with a narrower range of pseudo-resistance factors.…”

“…Considering the fact that, in comparison with our previous work [10], the group of patients with resistant hypertension was expanded, including the addition of patients with pseudo-resistance of various origins, it was important to determine whether this affected the emergence of any new differences be-tween the indicators (Tab. 4).…”

“…In our previous article describing the initial phase of the study, we have already explained the reasons for the lower BMI and higher aldosterone levels in the presence of true resistance [10]. At the same time, our new data regarding the difference in SBP levels in true and pseudo-resistance even when target BP levels are reached can be explained by the difference in aldosterone levels and its effect on the sympathetic tone of the autonomic nervous system, which in turn leads to poorer BP control as reflected by office and out-of-office BP [19][20][21][22].…”

“…This study is a continuation of our previous work on the establishment of the characteristics of hemodynamic and metabolic parameters in RH in obese patients [10]. In this study, the sample of patients has been expanded and not only patients whose pseudo-resistance is due to poor compliance with the therapy and non-compliance with the doctor's instructions to increase physical activity (but also for other reasons) are included.…”

Factors affecting blood pressure in patients with arterial hypertension and subclinical hypothyroidism

“…Low-grade inflammation and dysfunction of oxidative and antioxidant processes, which underlie the development of many chronic non-communicable diseases and are common in patients with SH [21][22][23][24], were found in patients with a combined course of hypertension and SH in our study. Interestingly, SIRT1, which plays a protective role in the development of oxidative stress [25], was elevated in patients with HTN and SH.…”