Structure of patients with resistant arterial hypertension

Background. Patients with uncontrolled blood pressure (BP) have a fourfold increase in the risk of developing cardiovascular events compared to those with hypertension who have reached the target blood pressure. The purpose of the study was to evaluate the structural characteristics of patients with resistant arterial hypertension (AH) undergoing in-patient treatment at the department of symptomatic hypertensions of the SI “NSC “M.D. Strazhesko Institute of Cardiology” of the National Academy of Medical Sciences of Ukraine” and to determine the achievement of the target blood pressure in patients with resistant AH taking three or more antihypertensive drugs. Materials and methods. The study included 1,146 patients with resistant AH who received 3 or more antihypertensive drugs and were treated at the department of symptomatic hypertensions of the SI “NSC “M.D. Strazhesko Institute of Cardiology” of the National Aca-demy of Medical Sciences of Ukraine”. The level of office BP at admission to the department was ≥ 140/90 mmHg if patients took 3 or more AH drugs. The average level of systolic (SBP)/diastolic blood pressure (DBP) was 174.60 ± 0.64/100.50 ± 0.38 mmHg. Patients underwent the following examinations: body height and weight measurements, office BP, daily blood pressure monitoring, echocardiography, pulse wave velocity and central blood pressure, sleep apnea determination, general blood count, blood biochemical analysis, evaluating the levels of thyroid-stimulating hormone, Т3, Т4, blood renin, blood aldosterone and their correlation, determination of urine metanephrine, cortisol. Results. Among patients with resistant arterial hypertension, there were more women (63 %) than men (37 %). Secondary hypertension was found in 5 %; renoparenchymal arterial hypertension, adrenocortical adenoma with hyperaldesononism and abnormal thyroid function with hypothyroidism predominated in the structure. 16.6 % of patients with resistant arterial hypertension had type 2 diabetes mellitus, 15.8 % — a history of cerebrovascular accident, with an ischemic stroke prevalence of 12.8 %. Patients who did not achieve target SBP (31 %) had significantly higher blood pressure at admission. They had a significantly higher blood cortisol level (155.0 ± 44.0 ng/l vs 35.9 ± 20.8 ng/l), higher left ventricular mass index (147.50 ± 3.46 g/m2 vs 135.30 ± 1.74 g/m2), obesity (42.9 vs 37.5 %), kidney abnormality (2.7 vs 0.8 %), obliterating lower limb atherosclerosis (2.0 vs 0.2 %), structural alterations in the adrenal gland (3.0 vs 1.2 %), nephropathy (1.3 vs 0.2 %), and higher degree of heart failure (16.9 vs 8.5 %). The degree of office blood pressure reduction among patients who received 3 or more drugs was 43.47 ± 0.65 mmHg for SBP and 20.33 ± 0.74 mmHg for DBP, p < 0.001 for both values. The DBP did not differ significantly between patients taking 3 and 4 drugs or more — 19.88 and 20.81 mmHg, respectively, and the office SBP significantly decreased in patients taking 4 drugs or more — by 45.78 mmHg compared with the group taking 3 drugs — 41.3 mmHg, p < 0.001. Conclusions. Secondary arterial hypertension was found in 5 % of patients with resistant hypertension; renoparenchymal hypertension, adrenocortical adenoma with hyperaldesononism and abnormal thyroid function with hypothyroidism prevailed in the structure.