title: Tertiary work-up of apparent treatment-resistant hypertension.
abstract: Treatment-resistant hypertension (TRH) has regained attention with development of new methods for treatment. However, the prevalence of TRH varies considerably from primary to secondary and tertiary care. We aimed to assess the prevalence of true TRH in a population of patients with apparent TRH in a university hospital setting of tertiary work-up and also investigate reasons for poor BP control and evaluate how work-up can be performed in general practice and secondary care.
  
  
  
  In this cohort study, we characterize a study population from Oslo Renal Denervation (RDN) Study. Patients (n = 83) were referred for RDN from secondary care. All patients underwent thorough medical investigation and 24-h ambulatory blood pressure measurements (24ABPM) after directly observed therapy (DOT). We then assessed reasons for lack of BP control.
  
  
  
  Fifty-three of 83 patients did not have true TRH. Main reasons for non-TRH were poor drug adherence (32%), secondary hypertension (30%) and white coat hypertension (15%). Forty-seven percent achieved blood pressure control after DOT with subsequent 24ABPM. There were otherwise no statistically significant differences in patient characteristics between the true TRH and the non-TRH group.
  
  
  
  Despite being a highly selected cohort referred for tertiary work-up of apparent TRH, BP control was achieved or secondary causes were identified in almost two thirds of the patients. Thorough investigation according to guidelines and DOT with subsequent 24ABPM is needed in work-up of apparent TRH.
authors.affiliation: a Faculty of Medicine , University of Oslo , Oslo , Norway ;
authors.forename: Sondre
authors.initials: S
authors.lastname: Heimark
authors.affiliation: a Faculty of Medicine , University of Oslo , Oslo , Norway ;
authors.forename: Per Anders
authors.initials: PA
authors.lastname: Eskås
authors.affiliation: a Faculty of Medicine , University of Oslo , Oslo , Norway ;
authors.forename: Julian Eek
authors.initials: JE
authors.lastname: Mariampillai
authors.affiliation: b Department of Medical Biochemistry , Oslo University Hospital , Ullevaal , Oslo , Norway ;|c Section for Cardiovascular and Renal Research , Oslo University Hospital , Ullevaal , Oslo , Norway ;
authors.forename: Anne Cecilie K
authors.initials: AC
authors.lastname: Larstorp
authors.affiliation: a Faculty of Medicine , University of Oslo , Oslo , Norway ;|c Section for Cardiovascular and Renal Research , Oslo University Hospital , Ullevaal , Oslo , Norway ;|d Department of Nephrology , Oslo University Hospital , Ullevaal , Oslo , Norway ;
authors.forename: Aud
authors.initials: A
authors.lastname: Høieggen
authors.affiliation: a Faculty of Medicine , University of Oslo , Oslo , Norway ;|c Section for Cardiovascular and Renal Research , Oslo University Hospital , Ullevaal , Oslo , Norway ;|e Department of Cardiology , Oslo University Hospital , Ullevaal , Oslo , Norway ;|f Department of Internal Medicine , Oslo University Hospital , Ullevaal , Oslo , Norway.
authors.forename: Fadl Elmula M
authors.initials: FE
authors.lastname: Fadl Elmula
mesh_terms: D000959:Antihypertensive Agents / Q000494:pharmacology; D001794:Blood Pressure / Q000187:drug effects; D018660:Blood Pressure Monitoring, Ambulatory; D015331:Cohort Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*
chemical_list: D000959:Antihypertensive Agents
keywords: Blood pressure; secondary hypertension; treatment resistant hypertension