Characteristics of resistant hypertension: ageing, body mass index, hyperaldosteronism, cardiac hypertrophy and vascular stiffness

• Published in: Journal of human hypertension Vol. 25; no. 9; pp. 532 - 538
• Main Authors: Martins, L C, Figueiredo, V N, Quinaglia, T, Boer-Martins, L, Yugar-Toledo, J C, Martin, J F V, Demacq, C, Pimenta, E, Calhoun, D A, Moreno, H
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.09.2011; Nature Publishing Group
• Subjects: 631/443/592/1540; 631/443/7; 692/699/75/243; 692/699/75/593/2724; Aged; Aging; Aging - physiology; Aldosterone; Antihypertensives; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Blood pressure; Body Mass Index; Cardiology. Vascular system; Cardiomegaly - complications; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Demographic aspects; Diagnosis; Drug Resistance; Echocardiography; Endocrine disorders; Epidemiology; Female; Health Administration; Heart; Heart enlargement; Humans; Hyperaldosteronism - complications; Hypertension; Hypertension - drug therapy; Hypertension - etiology; Hypertrophy; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Obesity - complications; original-article; Patients; Public Health; Renin; Vascular Stiffness; Ventricle; cardiac hypertrophy; resistant hypertension; vascular stiffness; Endocrinopathy; Hypertension; Adrenal cortex diseases; Hyperaldosteronism; Ageing; Cardiovascular disease; Hyperadrenocorticism; Body mass index; Adrenal gland diseases; Stiffness
• ISSN: 0950-9240; 1476-5527
• DOI: 10.1038/jhh.2010.95

Resistant hypertension (RHTN) includes patients whose blood pressure (BP) is controlled with the use of four or more antihypertensive medications, and is referred to as ‘controlled resistant hypertension’ (CRH). While specifically comparing patients with CRH and uncontrolled resistant hypertension (UCRH), we hoped to identify distinguishing characteristics that would provide insight into factors contributing to resistance to antihypertensive therapies. RHTN patients were identified as controlled (CRH, n =43) or uncontrolled (UCRH, n =47). No statistical differences were observed between the CRH and UCRH subgroups with respect to age and gender. The body mass index, aldosterone–renin ratio and pulse wave velocity (PWV) were significantly higher in UCRH patients. Although both subgroups showed increased cardiac mass, left ventricular mass index was significantly higher in UCRH compared with CRH patients. Multivariate linear regression analysis indicated that PWV was significantly dependent on age in both UCRH and CRH patients; however, the influence of ageing was more pronounced in the former subgroup. Older age, greater vascular stiffness, higher aldosterone levels and greater left ventricular hypertrophy were significantly associated with lack of BP control in patients with RHTN. These findings suggest important possibilities in terms of preventing and better treating RHTN.