Resistant hypertension and target organ damage

Abstract

Cardiovascular (CV) complications such as myocardial infarction, heart failure, stroke and renal failure are related to both the degree and the duration of blood pressure (BP) increase. Resistant hypertension (RH) is associated with a higher risk of CV complications and a higher prevalence of target organ damage (TOD). The relationship between CV disease and TOD can be bidirectional. Elevated BP in RH may cause CV structural and functional alterations, and the development or persistence of left ventricular hypertrophy, aortic stiffness, atherosclerotic plaques, microvascular disease and renal dysfunction, may render hypertension more difficult to control. Specifically, RH is related to several conditions, including obesity, sleep apnea, diabetes, metabolic syndrome and hyperaldosteronism, characterized by an overexpression of humoral and hormonal factors that are involved in the development and maintenance of TOD. Optimal therapeutic strategies, including pharmacological treatment and innovative invasive methodologies, have been shown to achieve adequate BP control and induce the regression of TOD, thereby potentially improving patient prognosis.

Determinants of concentric left ventricular hypertrophy in patients with resistant hypertension: RESIST-POL study

“…It has been demonstrated that patients with concentric hypertrophy have poorer outcomes than patients presenting normal LV geometry. 3,4 Resistant hypertension (RHTN) is of major clinical importance since it is associated with higher cardiovascular risk [5][6][7][8] which can be dependent on concentric hypertrophy. However, RHTN often coexists with obstructive sleep apnea (OSA) 9,10 and metabolic syndrome (MS), which also predispose to LVH.…”

Comparison of eplerenone and spironolactone for the treatment of primary aldosteronism

“…We have previously reported that PA patients have a higher incidence of cardiovascular complications than age-and sex-matched patients with essential hypertension [5]. Several studies have shown that PA is common in patients with resistant hypertension, with a prevalence of approximately 20% [6], and PA is associated with a significant increase in risk of end-organ damage and cardiovascular events compared with more easily controlled hypertension [7].…”

Plasma membrane calcium ATPases (PMCAs) as potential targets for the treatment of essential hypertension

“…However, some current therapeutic strategies appear to be of limited effectiveness for an increasing number of patients, with multidrug resistance or poor adherence to treatment regimes being reported (Morisky et al, 2008;Tomaszewski et al, 2014;Vega & Bisognano, 2014;Vongpatanasin, 2014;Sakhuja et al, 2015). Resistant hypertension is associated with increased target organ damage and cardiovascular complications (Muiesan et al, 2013). As such, and alongside likely increasing demand from an increasingly ageing global population, there is a pressing need for development of new and more effective strategies to prevent and treat hypertension.…”