Avaliação das diferenças clínicas e laboratoriais entre pacientes com hipertensão arterial resistente versus pacientes com hipertensão arterial refratária

Abstract

Introduction: Resistant hypertension (RH) is defined as uncontrolled blood pressure (BP) despite the use of ≥3 anti-hypertensive drugs, or controlled requiring use of ≥4 drugs. In 2014, with a evaluation of participants of a cohort study, a subgroup of patients with RH (uncontrolled blood pressure (BP) despite the use of ≥5 anti-hypertensive drugs) has emerged as refractory hypertension (RfH). Studies have shown important differences between these two phenotypes. Objective: This scientific study aims to evaluate the differences between patients with RH and patients with RfH about age, race, gender, LDL and HDL cholesterol levels, obesity, Diabetes diagnosis, previous history of stroke and acute myocardial infarction (AMI), adherence, left ventricular hypertrophy, renal function. Methods: For this work, 120 subjects with RH were enrolled from a hypertension specialized Clinic and divided into: RH (n=72), and refractory hypertension (RfH, n=48). Subjects answered a epidemiological questionnaire and questions about risk factors and previous AMI and stroke, they had their blood pressure measured two different times, were submitted to echocardiography, biochemical analyses and the adherence was assessed through Morisky questionnaire. Results: In our sample of 120 patients of a specialized ambulatory, 74,4% of these were female, mean age was 62,77 years and 53,7% were black. Patients with refractory versus resistant hypertension tended to be younger but share similar characteristics including black race and female gender. In the group with RH, the mean level of LDL cholesterol was 109,5 mg/dl and of HDL cholesterol was 56,56 mg/dl, while in the group with RfH, the mean levels of LDL cholesterol and HDL cholesterol were 132,67 mg/dl and 49,91 mg/dl, respectively. The frequency of Obesity (BMI≥30 kg/m2 ) in group with RH was 46,4% while in the group with HRf was 54,5%. The frequencies of prior AMI were similar but there was a statistically significant difference of prior Stroke, with the highest frequency in refractory group (p=0,004). There was no difference in impaired renal function and there was a tendency of higher frequency of left ventricular hypertrophy (LVH) and a tendency of a worse therapeutic adherence in subgroup with RfH. Conclusion: Patients with RfH seems to be at increased cardiovascular risk compared with patients with RH. This new phenotype needs to be better understood as well as its causes and the best drug therapy.