Treatment efficiency of resistant hypertension in cardiologist’s office

Abstract

Background: The target values of blood pressure have not been achieved in our population of patients suffi ciently. The most diffi cult is a control of patients with resistant hypertension. We do not have data about effi ciency treatment of these patients today.Objectives: The aim of our study was to assess current treatment status and by antihypertensive treatment modifi cation we tried to reach an adequate blood pressure control. Methods: Fifty two patients suffering from resistant hypertension 2-3 degree ESC/ESH with high cardiovascular risk have been observed. Reaching of the target blood pressure values was verifi ed by 24-hour ambulatory blood pressure monitoring. Results:The target blood pressure values were achieved in 50 % of patients during 18 months. We noticed a statistically signifi cant difference (p<0.001) in a decrease of casual and 24-hour ambulatory blood pressure in the group of controlled hypertensive patients in comparison with a group where blood pressure did not decrease suffi ciently. In case of 50 % patients, the target blood pressure values have not been reached in spite of more antihypertensive drugs and a higher dose. Conclusion: Adequately and systematically controlled patients were treated less intensively in comparison with an inadequately controlled group. 24-hour blood pressure monitoring analysis confi rmed correction of the patological diurnal rhythm mostly in adequate blood pressure controlled group. In this group, we have noticed a statistically signifi cant decrease of blood urea and creatinin levels and albumin/creatinin ratio in urine. Resistant hypertension needs multi-faceted approach with consistent control of all comorbidities in a case of problematic blood pressure control (Tab. 6, Fig. 1, Ref. 21). Text in PDF www.elis.sk. Hermida RC, Ayala DE, Fontao MJ, Mojón A, Fernández JR.Chronotherapy with valsartan/amlodipine fi xed combination: improved blood pressure control of essential hypertension with bedtime dosing. Chronobiol Int 2010; 27 (6): 1287-1303. Hermida RC, Ayala DE, Mojón A, Fontao MJ, Fernández JR.Chronotherapy with valsartan/hydrochlorothiazide combination in essential hypertension: improved sleep-time blood pressure control with bedtime dosing. Chronobiol Int 2011; 28 (7): 601-610.

Predictors of blood pressure control in patients with resistant hypertension

“…Obesity (body mass index ≥ 30 kg/m 2 ) was present in 51.8 % of patients, current smoking in 7.0 % and smoking history in 27.2 %. Diabetes mellitus was present in 54 %, ischemic heart disease in 64.9 %, previous myocardial infarction in 13 Values are mean±SD, SBP -systolic blood pressure, DBP -diastolic blood pressure, HR -heart rate, SD -standard deviation, ARV -average real variability Tab. 1.…”

“…In the previous studies, non-dipping was found to be more common in the RH patients. In the RH patients, recovery of pathological diurnal rhythm was associated with an improved BP control (13). Moreover, non-dipping is known to be associated with the target organ damage (17), cardiovascular events and mortality (18).…”

“…Non-dipping was found to be more prevalent and a higher difference was found between offi ce and ambulatory blood pressure in RH. The improvement in dipping status was found to correlate with an improved BP control (13). However, the value of short term blood pressure variability in RH patients has not yet been assessed.…”

Diagnostic and therapeutic strategiesfor resistant arterial hypertension – focus on countries with emerging economies

“…The renin-angiotensin-aldosterone system (RAAS) is the main regulator of sodium and fl uid balance, and one of the major mechanisms involved in the pathogenesis of hypertension. Dual blockade of the RAAS with mineralocorticoid receptor antagonists, specifi cally spironolactone, in combination with an ACE inhibitor or ARB, is now routinely commonly used to treat RH (24,25,26).…”