title: Refractory and resistant hypertension: characteristics and differences observed in a specialized clinic.
abstract: Resistant hypertension (RH) is defined as uncontrolled blood pressure (BP) despite the use of ≥3 anti-hypertensive drugs, or controlled requiring use of ≥4 drugs. Recently, a new definition for an extreme phenotype of RH (uncontrolled BP using at least five drugs) has emerged-the refractory hypertension (RfH). Although characteristics of RH are well established, little is known about this newly described subgroup. For this work, 116 subjects with RH were enrolled from a specialized clinic and divided into RH (n = 80) and RfH (n = 36). Subjects were submitted to echocardiography, 24-hour ambulatory BP measurement and biochemical analyses. Logistic regression analysis demonstrated that: (1) white-coat effect (odds ratio [OR], 3.23; 95% confidence interval [CI], 1.12-9.27; P = .03), (2) black race (OR, 6.67; 95% CI, 1.99-16.16; P < .001), and (3) left ventricular mass index (OR, 1.02; 95% CI, 1.01-1.03; P = .04) were independent predictors of refractoriness. In conclusion, RfH and RH present different patient characteristics, and these phenotypic aspects can be useful for better understanding this harder-to-treat subgroup.
authors.affiliation: Faculty of Medical Sciences, Department of Pharmacology, Laboratory of Cardiovascular Pharmacology, University of Campinas, Campinas, SP, Brazil. Electronic address: rodrigo_modolo@yahoo.com.br.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Modolo
authors.affiliation: Faculty of Medical Sciences, Department of Pharmacology, Laboratory of Cardiovascular Pharmacology, University of Campinas, Campinas, SP, Brazil.
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: de Faria
authors.affiliation: Faculty of Medical Sciences, Department of Pharmacology, Laboratory of Cardiovascular Pharmacology, University of Campinas, Campinas, SP, Brazil.
authors.forename: Andréa Rodrigues
authors.initials: AR
authors.lastname: Sabbatini
authors.affiliation: Faculty of Medical Sciences, Department of Pharmacology, Laboratory of Cardiovascular Pharmacology, University of Campinas, Campinas, SP, Brazil.
authors.forename: Natália Ruggeri
authors.initials: NR
authors.lastname: Barbaro
authors.affiliation: Faculty of Medical Sciences, Department of Pharmacology, Laboratory of Cardiovascular Pharmacology, University of Campinas, Campinas, SP, Brazil.
authors.forename: Alessandra M V
authors.initials: AM
authors.lastname: Ritter
authors.affiliation: Faculty of Medical Sciences, Department of Pharmacology, Laboratory of Cardiovascular Pharmacology, University of Campinas, Campinas, SP, Brazil.
authors.forename: Heitor
authors.initials: H
authors.lastname: Moreno
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D044383:Black People / Q000706:statistics & numerical data; D018660:Blood Pressure Monitoring, Ambulatory; D003430:Cross-Sectional Studies; D004452:Echocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000208:ethnology / Q000209:etiology / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000208:ethnology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D012307:Risk Factors
chemical_list: D000959:Antihypertensive Agents; D015415:Biomarkers
keywords: Left ventricular hypertrophy; high blood pressure; white-coat effect