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Prevalence and clinical profile of refractory hypertension in a large cohort of patients with resistant hypertension

Journal of Human Hypertension volume 35, pages 709–717 (2021)Cite this article

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Abstract

Refractory hypertension (RfHT) is an extreme phenotype of resistant hypertension (RHT) and is considered uncontrolled blood pressure (BP) despite the use of five or more antihypertensives. The objective of this study was to characterize the prevalence and clinical profile of RfHT patients in a historical cohort of patients with RHT at two different times: before and after the introduction of spironolactone. First, this cross-sectional study evaluated 1048 RHT patients (72.3% females, mean [SD] age: 61.2 [11.3] years) referred to a hypertension clinic (prespironolactone period). All patients were submitted to a standard protocol including clinical and complementary exams. Second, the analysis evaluated patients after the introduction of spironolactone (postspironolactone period). Statistical analysis included bivariate comparisons between patients with RHT and patients with RfHT and logistic regressions to assess the independent correlations of RfHT. A total of 146 patients (13.9%) remained refractory despite the use of at least five antihypertensives (prespironolactone period). After the introduction of spironolactone, the prevalence increased to 17.6%. For any criterion, RfHT patients were younger and more obese. In the initial period, current smoking and left ventricular hypertrophy were independently correlated with RfHT. Furthermore, after spironolactone use, RfHT patients had lower aortic stiffness and peripheral artery disease (PAD), pointing to a lower cardiovascular risk despite the lack of BP control. Younger age and lower prevalence of PAD correlated independently with RfHT. In conclusion, there was a high prevalence of RfHT, especially in younger and obese patients, and spironolactone use seemed to reduce cardiovascular risk despite the lack of BP control.

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Fig. 1: Flowchart study: after the diagnosis of resistant hypertension, ABPM is mandatory in the follow-up, defining the therapeutic decision until the diagnosis of refractory hypertension.

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Funding

This study was supported by research grants from the Conselho Brasileiro de Desenvolvimento Científico e Tecnológico (CNPq, Distrito Federal, Brazil) and Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ, Brazil). The sponsors have no role in study design, data collection and analysis, results interpretation or in preparation, review, and approval of the manuscript.

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  1. These authors contributed equally: Bernardo Chedier, Elizabeth Silaid Muxfeldt

Authors and Affiliations

  1. Department of Internal Medicine, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil

    Bernardo Chedier, Christian Nejm Roderjan & Aline de Hollanda Cavalcanti

  2. Department of Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil

    Arthur Fernandes Cortez, Fernanda Oliveira de Carvalho Carlos & Bruno Dussoni Moreira dos Santos

  3. Department of Internal Medicine, School of Medicine, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil

    Elizabeth Silaid Muxfeldt

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  1. Bernardo Chedier
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Correspondence to Elizabeth Silaid Muxfeldt.

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Chedier, B., Cortez, A.F., Roderjan, C.N. et al. Prevalence and clinical profile of refractory hypertension in a large cohort of patients with resistant hypertension. J Hum Hypertens 35, 709–717 (2021). https://doi.org/10.1038/s41371-020-00406-2

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