Urinary albumin excretion is associated with true resistant hypertension

Abstract

Resistant (or refractory) hypertension (RH) is a clinical diagnosis based on blood pressure (BP) office measurements. About one third of subjects with suspected RH have indeed pseudo-resistant hypertension and 24-h ambulatory-blood pressure-monitoring aids to precisely identify them. Our aim was to determine those clinical, laboratory or echocardiographic variables that may be associated with subjects with sustained hypertension (namely true RH). We carried out a cross-sectional analysis of 143 patients consecutively enrolled with the clinical diagnosis of RH. All patients underwent clinicaldemographic, laboratory evaluation, 2D-echocardiography and 24-h ambulatory-blood pressure-monitoring. Pseudoresistant hypertension or white-coat RH was defined if office BP was X140 and/or 90 mm Hg and 24-h BP o130/ 80 mm Hg. One-hundred and three (72%) patients had true RH and 40 (28%) patients had white-coat RH. True RH patients had significantly higher diabetes prevalence and higher office-systolic blood pressure (SBP) levels. Regarding target organ damage, left ventricular mass index (LVMI) and 24-h urinary albumin excretion (UAE) were also higher in true RH after adjustment for possible confounders (P ¼ 0.031 and P ¼ 0.012, respectively). In a logistic regression analysis, only office-SBP (multivariate OR (95%CI): 1.030 (1.003-1.057), P ¼ 0.030) and UAE (multivariate OR (95% CI): 2.376 (1.225-4.608), P ¼ 0.010) were independently associated with true RH. We conclude that true resistant hypertension is associated with silent target organ damage, especially UAE. In patients with suspected RH, assessment of 24 h ambulatory BP is the most accurate way to detect a population with high risk for target-organ damage.

Non-hemodynamic factors associated to the risk of developing hypertensive cardiopathy

“…Therefore, a glycemia level even below the threshold for the diagnosis of diabetes mellitus, is undoubtedly an important risk factor for the development of hypertensive cardiopathy. Similarly to the present study, other authors found creatinine levels below the threshold for chronic renal disease in patients with HTN and damage to target organs [58,59].…”

Clinical Features of 8295 Patients With Resistant Hypertension Classified on the Basis of Ambulatory Blood Pressure Monitoring

“…Moreover, in untreated patients, an older age and a female sex were also related to the presence of white-coat hypertension. 12 Previous reports of patients with RH classified after ABPM have also observed that true resistant hypertensives more frequently have diabetes mellitus and target organ damage, such as left ventricular hypertrophy and microalbuminuria, 4,5 and the incidence of cardiovascular events was higher during the follow-up of those considered true RH. 6,7 With respect to age, although some authors have reported an older age in white-coat RH, 4,17 others related old age with true resistance.…”

“…This is also in agreement with previous reports where white-coat hypertension was present in 20% to 40% of patients attended in referral units. 2,4,5,7 Differences in the prevalence of white-coat RH were mainly attributed to the selection of either daytime or 24-hour as the criteria used for definition, as well as the cutoff value (130/80 or 135/85 mm Hg) used. Among different values obtained during ABPM, nocturnal BP is clearly the best prognostic indicator of the cardiovascular outcome, 7,20 so we chose 24-hour BP as the diagnostic criteria of true RH, because it contains both activity and resting BPs.…”

“…It is estimated that approximately one third of patients with suspected RH indeed have white-coat or isolated office RH, showing normal daytime or 24-hour ABPM values. [2][3][4] Elevated ABPM values in patients with RH are associated with a higher prevalence of target organ damage 4,5 and increased incidence of future cardiovascular events. 6 -8 However, these data come from relatively small populations attended in single referral units, whereas there is lack of data coming from large hypertensive populations representing usual clinical care.…”

Home versus ambulatory blood pressure monitoring in the diagnosis of clinic resistant and true resistant hypertension

“…2,5 In a study of 286 patients classified as resistant hypertensives (elevated CBP on at least three antihypertensive drugs), ABP monitoring confirmed true resistance to treatment in 56%, whereas the remaining 44% had the white coat phenomenon. 19 In a more recent study by Oliveras et al 20 in 143 patients with clinic RH, ABP monitoring confirmed RH in 72%, whereas 28% had white coat hypertension. These data are in line with the present study findings showing that despite the careful assessment of CBP in two study visits and after one pre-study visit more than one-third of subjects with CRH (36%) had low ABP (Figure 3).…”