Etiology of the drug-resistance in patients with uncontrolled arterial hypertension: the data from the specialized centre

Objective. To assess the etiology of drug-resistant hypertension in patients with combination therapy. Design and methods. Out-patient subjects (n = 336, 94 males and 242 females, mean age — 54 ± 3 years) were followed up for one year (every 2-4 weeks during first three months, and then every 3-6 months till one year of follow-up). Examination included assessment of cortisol and aldosterone levels, renin activity, duplex scan of renal arteries, sleep study. Results. Secondary hypertension was verified in 29 (8,6 %) patients: primary aldosteronism — in 9 cases, pheochromocytome — in 2 cases, intracranial tumor — in 2 cases, renovascular hypertension — in 16 subjects. Moderate-to-severe sleep apnea was diagnosed in 45 (13,4 %) patients, and 21 subject (6,3 %) demonstrated «white-coat hypertension». Inadequate therapy was the cause of resistant hypertension in 198 (59,1 %) cases and included low compliance, suboptimal treatment, and medical inertia. True refractory hypertension was diagnosed in 42 subjects (23 males and 19 females). We achieved significant blood pressure decrease during first three months of follow-up just by therapy optimization: 162 ± 8/98 ± 5 mm Hg at baseline vs. 134 ± 4/86 ± 2 mm Hg at 3-month visit (р < 0,001), and 167 ± 9/101 ± 6 mm Hg at baseline vs. 144 ± 4/94 ± 2 mm Hg in 3 months in true resistant hypertension (р < 0,01 for systolic blood pressure and р < 0,05 for diastolic blood pressure). Conclusion. Low compliance, suboptimal therapy regimen and medical inertia are the most common causes of drug-resistant hypertension. Sleep-breathing disorders are highly prevalent in subjects with refractory hypertension.

resistant hypertension, secondary hypertension, medical inertia, sleep-breathing disorders

1. Egan B.M., Zhao Y., Axon R.N. US Trends in prevalence, awareness, treatment, and control of hypertension, 1988-2008 // J. Am. Med. Assoc. — 2010. — Vol. 303, № 20. — Р. 2043-2050.

2. Шальнова C.A., Баланова Ю.А., Константинов В.В. и др. Артериальная гипертония: распространенность, осведомленность, прием антигипертензивных препаратов и эффективность лечения среди населения Российской Федерации // Рос. кардиол. журн. — 2006. — № 4. — C. 45-50.

3. Gifford R.W.Jr. Resistant hypertension: introduction and definitions // Hypertension. — 1988. — Vol. 11, Suppl. 2. — P. II 65-66.

4. Frohlich E.D. Classification of resistant hypertension // Hypertension. — 1988. — Vol. 11, № 3, Suppl. 2. — P. 67-70.

5. Calhoun D.A., Jones D., Textor S. et al. Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research // Circulation. — 2008. — Vol. 117, № 25. — P. e510-e526.

6. Garg J.P., Elliott W., Folker A. et al. Resistant hypertension revisited: a comparison of two university-based cohorts // Am. J. Hypert. — 2005. — Vol. 18, № 5. — P. 619-626.

7. National Kidney Foundation Kidney early evaluation program 2005 annual data report // Am. J. Kidney Dis. — 2005. — Vol. 46, Suppl. 3. — P. S58-S59.

8. Otero F.R., Grigorian L.S., Lado M.L. et al. Association between refractory hypertension and cardiometabolic risk. The HYPERFRE study // Nefrologia. — 2008. — Vol. 28, № 4. — P. 425-432.

9. Xiangyang C., Sung Jennifer C., Brixner D., Kahler K.H. Results of a retrospective, observational pilot study using electronic medical records to assess the prevalence and characteristics of patients with resistant hypertension in an ambulatory care setting // Clin. Ther. — 2009. — Vol. 31, № 5. — P. 1116 — 1123.

10. Fuchs F.D., Massierer D., Tonelli de Oliveira A.C. et al. Abstract 5854: Prevalence of truly resistant hypertension prospectively evaluated in a clinical setting // Circulation. — 2009. — Vol. 120. — P. S1163.

11. Чазова И.Е., Фомин В.В., Разуваева М.А., Вигдорчик А.В. Эпидемиологическая характеристика резистентной и неконтролируемой артериальной гипертензии в Российской Федерации (Российский регистр неконтролируемой и резистентной артериальной гипертензии РЕГАТА ПРИМА РЕзистентная Гипертония АрТериАльная — ПРичины И Механизмы рАзвития) // Системные гипертензии. — 2010. — № 3. — С. 34-41.

12. Bradley T.D., Floras J.S. Obstructive sleep apnoea and its cardiovascular consequences // Lancet. — 2009. — Vol. 373, № 9657. — P. 82-93.

13. Stowasser M., Gordon R.D., Gunasekera T.G. et al. High rate of detection of primary aldosteronism, including surgically treatable forms, after «non-selective» screening of hypertensive patients // J. Hypertens. — 2003. — Vol. 21, № 11. — P. 2149-2157.