title: Refractory hypertension: definition, prevalence, and patient characteristics.
abstract: Among patients with resistant hypertension (RHTN), there are those whose blood pressure (BP) remains uncontrolled in spite of maximal medical therapy. This retrospective analysis aims to characterize these patients with refractory hypertension. Refractory hypertension was defined as BP that remained uncontrolled after ≥3 visits to a hypertension clinic within a minimum 6-month follow-up period. Of the 304 patients referred for RHTN, 29 (9.5%) remained refractory to treatment. Patients with refractory hypertension and those with controlled RHTN had similar aldosterone levels and plasma renin activity (PRA). Patients with refractory hypertension had higher baseline BP (175±23/97±15 mm Hg vs 158±25/89±15 mm Hg; P=.001/.005) and heart rate, and higher rates of prior stroke and congestive heart failure. During follow-up, the BP of patients with refractory hypertension remained uncontrolled (168.4±14.8/93.8±17.7 mm Hg) in spite of use of an average of 6 antihypertensive medications, while those of patients with controlled RHTN decreased to 129.3±11.2/77.6±10.8 mm Hg. Spironolactone reduced the BP by 12.9±17.8/6.6±13.7 mm Hg in patients with refractory hypertension and by 24.1±16.7/9.2±12.0 mm Hg in patients with controlled RHTN. In patients with RHTN, approximately 10% remain refractory to treatment. Similar aldosterone and PRA levels and a diminished response to spironolactone suggest that aldosterone excess does not explain the treatment failure.
authors.affiliation: Department of Medicine, Philippine General Hospital, Manila, Philippines. czarina.md@gmail.com
authors.forename: Maria Czarina
authors.initials: MC
authors.lastname: Acelajado
authors.forename: Roberto
authors.initials: R
authors.lastname: Pisoni
authors.forename: Tanja
authors.initials: T
authors.lastname: Dudenbostel
authors.forename: Louis J
authors.initials: LJ
authors.lastname: Dell'Italia
authors.forename: Falynn
authors.initials: F
authors.lastname: Cartmill
authors.forename: Bin
authors.initials: B
authors.lastname: Zhang
authors.forename: Stacey S
authors.initials: SS
authors.lastname: Cofield
authors.forename: Suzanne
authors.initials: S
authors.lastname: Oparil
authors.forename: David A
authors.initials: DA
authors.lastname: Calhoun
mesh_terms: D000328:Adult; D000886:Anthropometry / Q000379:methods; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D001794:Blood Pressure / Q000187:drug effects; D001795:Blood Pressure Determination; D015897:Comorbidity; D018432:Drug Resistance, Multiple; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology; D007677:Kidney Function Tests / Q000379:methods; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014883:Water-Electrolyte Imbalance / Q000188:drug therapy / Q000378:metabolism
chemical_list: D000959:Antihypertensive Agents