Clinical characteristics of resistant hypertension evaluated by ambulatory blood pressure monitoring

What is resistant arterial hypertension?

PURPOSE

The current review is to describe the definition and prevalence of resistant arterial hypertension (RAH), the difference between refractory hypertension, patient characteristics and major risk factors for RAH, how RAH is diagnosed, prognosis and outcomes for patients.

MATERIALS AND METHODS

According to the WHO, approximately 1.28 billion adults aged 30-79 worldwide have arterial hypertension, and over 80% of them do not have blood pressure (BP) under control. RAH is defined as above-goal elevated BP despite the concurrent use of 3 or more classes of antihypertensive drugs, commonly including a long-acting calcium channel blocker, an inhibitor of the renin-angiotensin system (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker), and a thiazide diuretic administered at maximum or maximally tolerated doses and at appropriate dosing frequency. RAH occurs in nearly 1 of 6 hypertensive patients. It often remains unrecognised mainly because patients are not prescribed ≥3 drugs at maximal doses despite uncontrolled BP.

CONCLUSION

RAH distinctly increases the risk of developing coronary artery disease, heart failure, stroke and chronic kidney disease and confers higher rates of major adverse cardiovascular events as well as increased all-cause mortality. Timely diagnosis and treatment of RAH may mitigate the associated risks and improve short and long-term prognosis.

The relationship between circadian blood pressure variability and maternal/perinatal outcomes in women with preeclampsia with severe features

OBJECTIVE

To determine whether circadian blood pressure (BP) variation of women with preeclampsia (PE) with severe features was associated with adverse maternal/perinatal outcomes.

METHODS

173 women with PE with severe features were recruitedand categorized into three groups: dipper, non-dipper and reverse dipper type BP group.. Maternal and perinatal outcomes were compared among groups.

RESULTS

There were significant differences in gestational ages, premature delivery, retinopathy, HELLP syndrome, mean birth weight, rate of low birth weight infants and fetal growth restriction.

CONCLUSION

Aberrant circadian pattern of BP in women with PE with severe features was associated with several adverse maternal/perinatal outcomes.

Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association

Resistant hypertension (RH) is defined as above-goal elevated blood pressure (BP) in a patient despite the concurrent use of 3 antihypertensive drug classes, commonly including a long-acting calcium channel blocker, a blocker of the renin-angiotensin system (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker), and a diuretic. The antihypertensive drugs should be administered at maximum or maximally tolerated daily doses. RH also includes patients whose BP achieves target values on ≥4 antihypertensive medications. The diagnosis of RH requires assurance of antihypertensive medication adherence and exclusion of the "white-coat effect" (office BP above goal but out-of-office BP at or below target). The importance of RH is underscored by the associated risk of adverse outcomes compared with non-RH. This article is an updated American Heart Association scientific statement on the detection, evaluation, and management of RH. Once antihypertensive medication adherence is confirmed and out-of-office BP recordings exclude a white-coat effect, evaluation includes identification of contributing lifestyle issues, detection of drugs interfering with antihypertensive medication effectiveness, screening for secondary hypertension, and assessment of target organ damage. Management of RH includes maximization of lifestyle interventions, use of long-acting thiazide-like diuretics (chlorthalidone or indapamide), addition of a mineralocorticoid receptor antagonist (spironolactone or eplerenone), and, if BP remains elevated, stepwise addition of antihypertensive drugs with complementary mechanisms of action to lower BP. If BP remains uncontrolled, referral to a hypertension specialist is advised.

Does sympathetic overactivation feature all hypertensives? Differences of sympathovagal balance according to night/day blood pressure ratio in patients with essential hypertension

When evaluating the 'night/day BP ratio', both hypertensives and normotensives can be arbitrarily classified into four groups: extreme dippers (ratio ⩽0.8), dippers (0.8 Collapse

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MESH Headings

• Aged
• Blood Pressure/physiology
• Blood Pressure Monitoring, Ambulatory
• Circadian Rhythm/physiology
• Essential Hypertension
• Female
• Heart Rate/physiology
• Humans
• Hypertension/physiopathology
• Male
• Middle Aged
• Sympathetic Nervous System/physiopathology

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Affiliation(s)

Domenico Di Raimondo UOC Medicina Interna e Cardioangiologia, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S), Università degli Studi di Palermo, Palermo, Italy
Giuseppe Miceli UOC Medicina Interna e Cardioangiologia, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S), Università degli Studi di Palermo, Palermo, Italy
Alessandra Casuccio Dipartimento di Scienze per la Promozione della Salute e Materno Infantile, Università degli Studi di Palermo, Palermo, Italy
Antonino Tuttolomondo UOC Medicina Interna e Cardioangiologia, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S), Università degli Studi di Palermo, Palermo, Italy
Carmelo Buttà UOC Medicina Interna e Cardioangiologia, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S), Università degli Studi di Palermo, Palermo, Italy
Valentina Zappulla UOC Medicina Interna e Cardioangiologia, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S), Università degli Studi di Palermo, Palermo, Italy
Caterina Schimmenti UOC Medicina Interna e Cardioangiologia, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S), Università degli Studi di Palermo, Palermo, Italy
Gaia Musiari UOC Medicina Interna e Cardioangiologia, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S), Università degli Studi di Palermo, Palermo, Italy
Antonio Pinto UOC Medicina Interna e Cardioangiologia, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S), Università degli Studi di Palermo, Palermo, Italy

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