title: Prevalence of resistant hypertension and associated factors in Japanese subjects with type 2 diabetes.
abstract: OBJECTIVE
  The prevalence of treatment resistant hypertension (RH) depends on methods used for blood pressure (BP) measurements, goals of BP, and therapeutic efforts in terms of medication and adherence. We focused on diabetic subjects and explored the prevalence of RH in primary care practice.
  
  
  METHODS
  In 1737 subjects with type 2 diabetes who continued regular visits, office BP was evaluated by multiple measurements over one year. RH was defined as using more than four antihypertensive drugs or failure to achieve the goal with three antihypertensive drugs from different classes. The RH prevalence was investigated with BP goals <130/80 and 140/90 mmHg.
  
  
  RESULTS
  The percentage of subjects who achieved BP goals <130/80 and 140/90 were 70.5% and 93.8% with adherence to medication ≥95%, and the corresponding prevalence rates of RH in treated subjects were 28.4% and 21.8%, respectively. Factors independently associated with RH were age (odds ratio 1.02 [95% CI 1.01-1.04]), body mass index (1.10 [1.06-1.13]), variability in systolic BP (1.06 [1.02-1.09]), triglycerides (2.86 [1.34-6.11]), macroalbuminuria (3.33 [2.03-5.48]), estimated glomerular filtration rate (0.98 [0.97-0.99]), retinopathy (1.91 [1.39-2.61]), and family history of hypertension (1.85 [1.23-2.21]). Worsening albuminuria and glomerular filtration rate enhanced the prevalence of RH in a graded manner.
  
  
  CONCLUSIONS
  Careful estimation of office BP values over one year with a high achievement of BP goals and adequate adherence revealed that the prevalence of RH in type 2 diabetes is high. RH was characterized by accumulation of cardiovascular genetic and environmental risks.
authors.affiliation: Jiyugaoka Medical Clinic, Internal Medicine, Obihiro, Japan. Electronic address: dryokoyama@yokoyamanaika.com.
authors.forename: H
authors.initials: H
authors.lastname: Yokoyama
authors.affiliation: Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Araki
authors.affiliation: Jiyugaoka Medical Clinic, Internal Medicine, Obihiro, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Watanabe
authors.affiliation: Jiyugaoka Medical Clinic, Internal Medicine, Obihiro, Japan; Department of Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.
authors.forename: J
authors.initials: J
authors.lastname: Honjo
authors.affiliation: Jiyugaoka Medical Clinic, Internal Medicine, Obihiro, Japan; Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Okizaki
authors.affiliation: Jiyugaoka Medical Clinic, Internal Medicine, Obihiro, Japan.
authors.forename: D
authors.initials: D
authors.lastname: Yamada
authors.affiliation: Jiyugaoka Medical Clinic, Internal Medicine, Obihiro, Japan.
authors.forename: R
authors.initials: R
authors.lastname: Shudo
authors.affiliation: Jiyugaoka Medical Clinic, Internal Medicine, Obihiro, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Shimizu
authors.affiliation: Jiyugaoka Medical Clinic, Internal Medicine, Obihiro, Japan; Department of Internal Medicine, Niigata University, Faculty of Medicine, Niigata, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Sone
authors.affiliation: Department of Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Haneda
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000453:epidemiology; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000502:physiology; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D004351:Drug Resistance; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology*; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors
chemical_list: D000959:Antihypertensive Agents
keywords: Prevalence; Resistant hypertension; Risk factors; Therapeutics; Type 2 diabetes mellitus