title: Resistant hypertension in patients with type 2 diabetes: clinical correlates and association with complications.
abstract: OBJECTIVE
  The phenotype of resistant hypertension in patients with type 2 diabetes has been poorly characterized. This cross-sectional analysis of the large cohort from the Renal Insufficiency and Cardiovascular Events (RIACE) study was aimed at assessing the clinical correlates and association with complications of resistant hypertension in patients with type 2 diabetes.
  
  
  METHODS
  The RIACE study enrolled 15,773 patients consecutively visiting 19 diabetes clinics during the years 2007-2008. Resistant hypertension, defined as BP values not on target (i.e. >130/80 mmHg, respectively) with three antihypertensive agents, was detected in 2363 individuals (15% of the whole RIACE cohort, 17.4% of hypertensive individuals, and 21.2% of treated hypertensive patients). Patients without resistant hypertension [nonresistant hypertension (NRH)], that is on target with one (n = 1569), two (n = 1369), and three (n = 803) drugs, and individuals with uncontrolled hypertension, that is untreated or not on target with less than three drugs (n = 7440), served as controls.
  
  
  RESULTS
  As compared with NRH and uncontrolled hypertension patients, patients with resistant hypertension were older and more frequently women and had significantly higher waist circumference, albuminuria, and serum creatinine, and lower glomerular filtration rate. Prevalence values of chronic kidney disease and advanced retinopathy were significantly higher in resistant hypertension than in both nonresistant hypertension and uncontrolled hypertension individuals, whereas cardiovascular disease was more frequent in resistant hypertension versus uncontrolled hypertension, but not nonresistant hypertension patients, especially those on 2-3 drugs.
  
  
  CONCLUSIONS
  Resistant hypertension is relatively common in patients with type 2 diabetes. In these individuals, age, female sex and waist circumference are independent correlates of resistant hypertension, which is strongly associated with microvascular (especially renal) disease, whereas relation with macrovascular complications is unclear.
authors.affiliation: aDepartment of Clinical and Experimental Medicine, University of Pisa, Pisa bDivision of Endocrinology and Metabolic Diseases, University of Verona, Verona cDiabetes Unit, Fondazione IRCCS 'Cà Granda-Ospedale Maggiore Policlinico', Milan dDiabetes Unit, University of Siena, Siena eEndocrinology and Diabetes Unit, Ospedali Riuniti, Bergamo fDepartment of Clinical and Experimental Medicine, University of Padua, Padua gDepartment of Clinical and Biological Sciences, University of Turin, Orbassano, Turin hDepartment of Medical Sciences, University of Foggia, Foggia iEndocrinology Unit, San Giuseppe Hospital, Milan jDepartment of Medical Sciences, University of Cagliari, Cagliari kDepartment of Clinical and Molecular Medicine, 'La Sapienza' University, Rome, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Solini
authors.forename: Giacomo
authors.initials: G
authors.lastname: Zoppini
authors.forename: Emanuela
authors.initials: E
authors.lastname: Orsi
authors.forename: Cecilia
authors.initials: C
authors.lastname: Fondelli
authors.forename: Roberto
authors.initials: R
authors.lastname: Trevisan
authors.forename: Monica
authors.initials: M
authors.lastname: Vedovato
authors.forename: Franco
authors.initials: F
authors.lastname: Cavalot
authors.forename: Olga
authors.initials: O
authors.lastname: Lamacchia
authors.forename: Maura
authors.initials: M
authors.lastname: Arosio
authors.forename: Marco G
authors.initials: MG
authors.lastname: Baroni
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Penno
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pugliese
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000150:complications; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D007558:Italy / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000453:epidemiology*; D055105:Waist Circumference
chemical_list: D000959:Antihypertensive Agents