scholarly journals Resistant and refractory arterial hypertension: similarities and differences, new approaches to diagnosis and treatment

2018 ◽  
Vol 15 (3) ◽  
pp. 11-13 ◽  
Author(s):  
A V Aksenova ◽  
T E Esaulova ◽  
O A Sivakova ◽  
I E Chazova
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Arterial Hypertension ◽  
Treatment Failure ◽  
Resistant Hypertension ◽  
Antihypertensive Treatment ◽  
Patient Characteristics ◽  
Refractory Hypertension ◽  
Long Time ◽  
Similarities And Differences

Refractory hypertension is a novel phenotype of antihypertensive treatment failure. The terms "refractory hypertension" and "resistant hypertension" were considered interchangeable for a long time and related to difficult-to-treat hypertension. Recently, the term "refractory hypertension" refers to a very small group of patients who do not really reach the target blood pressure for maximum antihypertensive therapy. In this review we discuss similarities and contrasts definition, prevalence, patient characteristics, risk factors, and possible underlying etiologies of refractory and resistant hypertension.

scholarly journals Clinical features and course of arterial hypertension in patients with its various forms

2021 ◽  
Vol 18 (3) ◽  
pp. 140-146
Author(s):  
Anastasiia R. Denisova ◽  
Tatiana E. Esaulova ◽  
Tatiana D. Solntseva ◽  
Olga A. Sivakova ◽  
Irina E. Chazova
Keyword(s):  
Risk Factors ◽  
Arterial Hypertension ◽  
Resistant Hypertension ◽  
Clinical Laboratory ◽  
Target Organ Damage ◽  
Left Ventricular ◽  
Uncontrolled Hypertension ◽  
Refractory Hypertension ◽  
Significant Difference ◽  
History Of

Aim. To study the main risk factors, clinical, laboratory and instrumental data, concomitant cardiovascular diseases (CVD) and associated clinical conditions in patients with controlled and uncontrolled hypertension, controlled resistant and uncontrolled resistant hypertension, refractory hypertension, and probably resistant and probably refractory hypertension based on retrospective analysis. Materials and methods. The study included 455 patients with hypertension. All patients were divided into 7 groups. The group of controlled hypertension included 240 patients (52.75%), controlled resistant hypertension 61 (13.4%), uncontrolled hypertension 10 (2.2%), uncontrolled resistant hypertension 53 (11.65%), refractory hypertension 63 (13.8%), probably resistant hypertension 15 (3.3%), probably refractory hypertension 13 (2.9%). Anamnesis (assessment of the duration and age of the onset of arterial hypertension, assessment of the presence of CVD), risk factors for the development of hypertension (obesity, dyslipidemia, impaired glucose tolerance and fasting glycemia, hyperuricemia, family history of CVD, early menopause in women; heart rate 80 beats/min, smoking), laboratory parameters (creatinine, glucose, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, uric acid) and instrumental methods of examination (ECG, echocardiography, clinic mean 24h BP, Holter monitoring, duplex BCA scanning) were assessed in all groups of patients based on the analysis of the medical history. Results. In this article we presented the results of a comparative analysis of patients with controlled hypertension, uncontrolled resistant hypertension, refractory and probably refractory hypertension. Patients with refractory hypertension were significantly more young, non-smokers and females compared with patients with uncontrolled resistant hypertension and controlled hypertension. Patients with refractory hypertension had greater prevalence of left ventricular hypertrophy according to ECG and echocardiography (p0.05). Fundus lesions were found exclusively in patients with uncontrolled hypertension, 55% of cases were found in the group of refractory hypertension (p0.05). There were no significant differences in the presence of BCA atherosclerosis between the groups. Patients with refractory hypertension were significantly more likely to have heart failure, a history of stroke and transient ischemic attack compared with patients from the group of controlled hypertension (p0.05). There was no significant difference in the presence of chronic kidney disease, type 2 diabetes mellitus, coronary heart disease, atrial fibrillation between the groups. Conclusion. Patients with refractory hypertension are significantly more likely to have target organ damage and concomitant cardiovascular, cerebrovascular diseases than patients with controlled hypertension.

RESISTANT ARTERIAL HYPERTENSION IN PATIENTS WITH CHRONIC KIDNEY DISEASE: PREVALENCE, PROGNOSTIC SIGNIFICANCE, REASONS AND APPROACHES TO ANTIHYPERTENSIVE THERAPY

2019 ◽  
Vol 23 (1) ◽  
pp. 37-44 ◽  
Author(s):  
O. B. Kuzmin ◽  
V. V. Zhezha ◽  
L. N. Landar ◽  
O. A. Salova
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Drug Therapy ◽  
Kidney Disease ◽  
Arterial Hypertension ◽  
Antihypertensive Therapy ◽  
Resistant Hypertension ◽  
Antihypertensive Drugs ◽  
Refractory Hypertension ◽  
Hypertensive Patients

Arterial hypertension (AH) resistant to drug therapy is the phenotype of uncontrolled AH, in which patients receiving at least 3 antihypertensive drugs, including a diuretic, maintain blood pressure above the target level. Initially, the term refractory hypertension was also used to refer to resistant hypertension. Recently, however, refractory hypertension has been isolated into a separate phenotype of difficult to treat hypertension, which is defined as insufficient control of target blood pressure, despite the use of at least 5 different mechanisms of antihypertensive drugs, including long-acting diuretic and antagonist of mineralcorticoid receptors. Resistant hypertension is detected in 10–15 % of all hypertensive patients receiving drug therapy, and is often found in patients with chronic kidney disease. Hypertension can be a cause and/or consequence of kidney damage and is typical of most patients with chronic kidney disease. The lack of control of target blood pressure in a significant proportion of hypertensive patients with CKD who receive at least 3 antihypertensive drugs of different mechanisms of action indicates a lack of effectiveness of antihypertensive therapy, which not only accelerates the loss of renal function, but also significantly worsens the prognosis, contributing to such people risk of cardiovascular and renal complications. The review presents data on the prevalence, prognostic value of resistant hypertension in patients with chronic kidney disease, features of its formation and approaches to increasing the effectiveness of antihypertensive therapy in this patient population.

Abstract 57: Risk Factors For Severe Reductions In Blood Pressure After Treatment Of Severe Inpatient Hypertension

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Lama Ghazi ◽  
Fan Li ◽  
Eric Chen ◽  
Michael Simonov ◽  
Yu Yamamoto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cohort Study ◽  
Hospital Admission ◽  
Antihypertensive Treatment ◽  
Treatment Guidelines ◽  
P Value ◽  
Antihypertensive Medications ◽  
Black Race ◽  
Oral Medications

Background: Incident severe HTN during hospitalization is far more common than admission for HTN, however treatment guidelines are lacking. Severe inpatient HTN is poorly studied, therefore our goal is to characterize inpatients who develop severe HTN and assess BP response to antihypertensive treatment. Methods: This is a cohort study of adults admitted for reasons other than HTN and developed severe HTN within a single healthcare system. We defined severe inpatient HTN as the first documentation of BP elevation (>180 systolic or >110 diastolic) at least 1 hour after hospital admission. Treatment was defined as receiving antihypertensive medications within 6 hours of BP elevation. We studied the association between treatment and BP drop ≥30%. Results: Among 224,265 hospitalized adults, 23,147 developed severe HTN of which 40% were treated. Compared to inpatients who did not develop severe HTN, those who did were older, more commonly women and Black, and had more comorbidities. Of the treated and untreated patients, 45.5 and 46.4% had a MAP drop ≥30% (p-value= 0.2). Risk factors for severe MAP drop include older age, Black race, HTN, and diabetes. Additionally, treatment vs. no treatment and treatment with intravenous vs. oral medications were associated with greater odds of MAP drop ≥30% ( Table 1 ). Conclusion: While there was no difference in the proportion of treated and untreated patients with severe MAP reduction, after adjustment for factors independently associated with HTN we found that treatment was associated with severe BP drop. Further research is needed to phenotype inpatients with severe HTN to help establish treatment guidelines.

scholarly journals Reserpine Substantially Lowers Blood Pressure in Patients With Refractory Hypertension: A Proof-of-Concept Study

2020 ◽  
Vol 33 (8) ◽  
pp. 741-747 ◽  
Author(s):  
Mohammed Siddiqui ◽  
Hemal Bhatt ◽  
Eric K Judd ◽  
Suzanne Oparil ◽  
David A Calhoun
Keyword(s):  
Blood Pressure ◽  
Antihypertensive Treatment ◽  
Proof Of Concept ◽  
Open Label ◽  
Refractory Hypertension ◽  
Antihypertensive Medications ◽  
Mineralocorticoid Receptor Antagonist ◽  
Antihypertensive Regimen ◽  
Automated Office Blood Pressure ◽  
Current Clinical Trial

Abstract BACKGROUND Refractory hypertension (RfHTN), a phenotype of antihypertensive treatment failure, is defined as uncontrolled automated office blood pressure (AOBP) ≥130/80 mm Hg and awake ambulatory blood pressure (ABP) ≥130/80 mm Hg on ≥5 antihypertensive medications, including chlorthalidone and a mineralocorticoid receptor antagonist. Previous studies suggest that RfHTN is attributable to heightened sympathetic tone. The current study tested whether reserpine, a potent sympatholytic agent, lowers blood pressure (BP) in patients with RfHTN. METHODS Twenty-one out of 45 consecutive patients with suspected RfHTN were determined to be fully adherent with their antihypertensive regimen. Seven patients agreed to participate in the current clinical trial with reserpine and 6 patients completed the study. Other sympatholytic medications, such as clonidine or guanfacine, were tapered and discontinued before starting reserpine. Reserpine 0.1 mg daily was administered in an open-label fashion for 4 weeks. All patients were evaluated by AOBP and 24-hour ABP at baseline and after 4 weeks of treatment. RESULTS Reserpine lowered mean systolic and diastolic AOBP by 29.3 ± 22.2 and 22.0 ± 15.8 mm Hg, respectively. Mean 24-hour systolic and diastolic ABPs were reduced by 21.8 ± 13.4 and 15.3 ± 9.6 mm Hg, mean awake systolic and diastolic ABPs by 23.8 ± 11.8 and 17.8 ± 9.2 mm Hg, and mean asleep systolic and diastolic ABPs by 21.5 ± 11.4 and 13.7 ± 6.4 mm Hg, respectively. CONCLUSIONS Reserpine, a potent sympatholytic agent, lowers BP in patients whose BP remained uncontrolled on maximal antihypertensive therapy, lending support to the hypothesis that excess sympathetic output contributes importantly to the development of RfHTN.

scholarly journals Diuretics in treatment of patients with arterial hypertension

2009 ◽  
Vol 6 (4) ◽  
pp. 9-12
Author(s):  
Irina Evgen'evna Chazova ◽  
Lyudmila Gennadievna Ratova
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Coronary Artery Disease ◽  
Cardiovascular Risk ◽  
Arterial Hypertension ◽  
Disease Process ◽  
Low Doses ◽  
Treatment Of Hypertension ◽  
Artery Disease ◽  
High Doses

Since all cardiovascular risk factors contribute to coronary artery disease in patients with arterial hypertension, they should all be considered in the management of this disease process. Thiazides diuretics when used at high doses, negatively impact lipid and glucose metabolism. These findings have resulted in decreased use of diuretics in favor of newer agents such as ACE inhibitors and calcium antagonists. However, recent data have demonstrated that when used at low doses (6.25 or 25 mg of hydrochlorothiazide), diuretics lack significant metabolic side effects while bringing about significant reductions in blood pressure. Thus, at these doses, hydrochlorothiazide is a useful drug in the treatment of hypertension, both as monotherapy and in combination therapy.

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