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Urinary albumin excretion is associated with true resistant hypertension

Journal of Human Hypertension volume 24, pages 27–33 (2010)Cite this article

Abstract

Resistant (or refractory) hypertension (RH) is a clinical diagnosis based on blood pressure (BP) office measurements. About one third of subjects with suspected RH have indeed pseudo-resistant hypertension and 24-h ambulatory-blood pressure-monitoring aids to precisely identify them. Our aim was to determine those clinical, laboratory or echocardiographic variables that may be associated with subjects with sustained hypertension (namely true RH). We carried out a cross-sectional analysis of 143 patients consecutively enrolled with the clinical diagnosis of RH. All patients underwent clinical-demographic, laboratory evaluation, 2D-echocardiography and 24-h ambulatory-blood pressure-monitoring. Pseudo-resistant hypertension or white-coat RH was defined if office BP was ⩾140 and/or 90 mm Hg and 24-h BP <130/80 mm Hg. One-hundred and three (72%) patients had true RH and 40 (28%) patients had white-coat RH. True RH patients had significantly higher diabetes prevalence and higher office-systolic blood pressure (SBP) levels. Regarding target organ damage, left ventricular mass index (LVMI) and 24-h urinary albumin excretion (UAE) were also higher in true RH after adjustment for possible confounders (P=0.031 and P=0.012, respectively). In a logistic regression analysis, only office-SBP (multivariate OR (95%CI): 1.030 (1.003–1.057), P=0.030) and UAE (multivariate OR (95% CI): 2.376 (1.225–4.608), P=0.010) were independently associated with true RH. We conclude that true resistant hypertension is associated with silent target organ damage, especially UAE. In patients with suspected RH, assessment of 24 h ambulatory BP is the most accurate way to detect a population with high risk for target-organ damage.

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Acknowledgements

This study was partially supported by a grant from the Societat Catalana d’Hipertensió Arterial.

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Author notes

  1. A Oliveras: HERACLES' research net Investigator.

Authors and Affiliations

  1. Nephrology Division, Medicine Department, Hypertension Unit, Hospital Universitari del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain

    A Oliveras

  2. Internal Medicine Department, Hypertension Unit, Hospital General de l'Hospitalet, Universitat de Barcelona, Barcelona, Spain

    P Armario & R Hernández-del Rey

  3. Internal Medicine Department, Hypertension Unit, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain

    J A Arroyo & À Roca-Cusachs

  4. Nephrology Department, Hypertension Unit, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain

    E Poch

  5. Internal Medicine Department, Hypertension Unit, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain

    M Larrousse & A de la Sierra

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Oliveras, A., Armario, P., Hernández-del Rey, R. et al. Urinary albumin excretion is associated with true resistant hypertension. J Hum Hypertens 24, 27–33 (2010). https://doi.org/10.1038/jhh.2009.35

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