[Frequency of hypertension resistant to treatment and indication for renal denervation].
OBJECTIVE
To evaluate in hypertensive patients followed in a specialized hypertension unit, the prevalence of subjects uncontrolled despite triple therapy including a diuretic. The aim is to estimate the percentage of hypertensive patients with an indication to renal denervation.


METHODS
From a database of computerized medical records of a unit specialized in hypertension, it was extracted 144 consecutive cases of subjects treated and followed for at least 1year and having had a home pressure monitoring (HPM) on treatment, and if necessary a work-up for a secondary hypertension. The blood pressure (BP) was evaluated in office by automated method (after 2 and 8minutes) and with HPM (average of three measurements in the morning and evening for three consecutive days).


RESULTS
The population has the following characteristics: age 62 with 26% over 70years, treated dyslipidemia (39%), treated diabetes (11%), adrenal hypertension treated medically (14%), severe renal failure (3%). The means of treatment are: a monotherapy (33%), bitherapy (35%), triple therapy (17%), quadritherapy (7%), pentatherapy or more (1%), spironolactone (45%), thiazide diuretics (49%). The uncontrolled hypertension was observed in 26% if the BP is evaluated with HPM, in 52% if the BP is evaluated at the office after 2minutes of rest and 7% if the BP is evaluated after 8minutes of rest (P<0.01). In patients treated with at least a tritherapy in association with a diuretic, an uncontrolled hypertension was observed in 5% if the BP is evaluated with HPM. Failure to control for the SBP is the cause of 80% of resistant hypertension.


CONCLUSIONS
The frequency of resistant hypertension is 5% of hypertensive patients followed in a specialized hypertension unit when guidelines are applied in the case of uncontrolled hypertension. These results indicate that the indication for renal denervation affects only a small percentage of patients treated for hypertension.
Unité de prévention cardiovasculaire, pôle cœur métabolisme, hôpital de La Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
D
D
Rosenbaum
F
F
Villeneuve
C
C
Gury
X
X
Girerd
D000368:Aged; D000465:Algorithms; D000959:Antihypertensive Agents / Q000627:therapeutic use; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm; D048909:Diabetes Complications / Q000453:epidemiology; D004232:Diuretics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D050171:Dyslipidemias / Q000150:complications / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D015995:Prevalence; D012077:Renal Artery / Q000294:innervation* / Q000601:surgery*; D012307:Risk Factors; D013562:Sympathectomy / Q000379:methods*; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D004232:Diuretics