Original Article

Journal of Human Hypertension (2011) 25, 532–538; doi:10.1038/jhh.2010.95; published online 7 October 2010

Characteristics of resistant hypertension: ageing, body mass index, hyperaldosteronism, cardiac hypertrophy and vascular stiffness

L C Martins1, V N Figueiredo1, T Quinaglia1, L Boer-Martins1, J C Yugar-Toledo2, J F V Martin2, C Demacq1, E Pimenta3, D A Calhoun4 and H Moreno Jr1

  1. 1Cardiovascular Pharmacology Laboratory, Faculty of Medical Sciences and Clinic Hospital, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
  2. 2Hypertension Clinic, State Medical School at São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil
  3. 3Endocrine Hypertension Research Center and Clinical Center of Research Excellence in Cardiovascular Disease and Metabolic Disorders, University of Queensland School of Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia
  4. 4Vascular Biology and Hypertension Program, University of Alabama at Birmingham, Birmingham, AL, USA

Correspondence: Dr LC Martins, Cardiovascular Pharmacology Laboratory, Faculty of Medical Sciences and Clinic Hospital, State University of Campinas, FCM 10 Building, 1st Floor, Campinas, São Paulo 13083-970, Brazil. E-mail: luizpneumo@uol.com.br

Received 18 May 2010; Revised 20 July 2010; Accepted 3 September 2010; Published online 7 October 2010.

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Abstract

Resistant hypertension (RHTN) includes patients whose blood pressure (BP) is controlled with the use of four or more antihypertensive medications, and is referred to as ‘controlled resistant hypertension’ (CRH). While specifically comparing patients with CRH and uncontrolled resistant hypertension (UCRH), we hoped to identify distinguishing characteristics that would provide insight into factors contributing to resistance to antihypertensive therapies. RHTN patients were identified as controlled (CRH, n=43) or uncontrolled (UCRH, n=47). No statistical differences were observed between the CRH and UCRH subgroups with respect to age and gender. The body mass index, aldosterone–renin ratio and pulse wave velocity (PWV) were significantly higher in UCRH patients. Although both subgroups showed increased cardiac mass, left ventricular mass index was significantly higher in UCRH compared with CRH patients. Multivariate linear regression analysis indicated that PWV was significantly dependent on age in both UCRH and CRH patients; however, the influence of ageing was more pronounced in the former subgroup. Older age, greater vascular stiffness, higher aldosterone levels and greater left ventricular hypertrophy were significantly associated with lack of BP control in patients with RHTN. These findings suggest important possibilities in terms of preventing and better treating RHTN.

Keywords:

resistant hypertension; cardiac hypertrophy; vascular stiffness

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