Journal de l'hypertension : accès libre

True and Apparent Hypertension That is Resistant: Definition, Incidence and Effects

Abstract

Mehri Sounira

With increased efforts to improve BP control rates and the emergence of device-based therapies for hypertension, resistive hypertension; defined as blood pressure (BP) remaining above goal despite the use of three or more antihypertensive medications at maximally tolerated doses (one of which should ideally be a diuretic) has received more attention. Patients with true resistant hypertension, controlled resistant hypertension, and pseudo-resistant hypertension make up this classically defined resistant group. The term "apparent" resistant hypertension has been used to identify "apparent" lack of control on 3 medications in studies where pseudo-resistant hypertension cannot be excluded (for example, 24-hour ambulatory BP was not obtained).The prevalence of resistant hypertension has recently been reported in large, well-designed studies. The prevalence of resistant hypertension is 14.8% of treated hypertensive patients and 12.5% of all hypertensives, based on prevalence data from these studies and others in North America and Europe with a combined sample size of more than 600,000 hypertensive participants. However, in terms of identifying risk and estimating benefit from newer therapies like renal denervation, the prevalence of true resistant hypertension; defined as uncontrolled by office and 24-hour ambulatory BP monitoring with confirmed medication adherence; may be more significant. In patients with resistant hypertension, rates of cardiovascular events and mortality follow mean 24-hour ambulatory BPs, with true resistant hypertension representing the highest risk. In large trials, the prevalence of true resistant hypertension has not been directly measured; however, the combined results of a number of smaller studies suggest that true resistant hypertension is present in half of the office-controlled resistant hypertensive patients. Uncontrolled resistant hypertension is prevalent in 10.1% of treated hypertensive patients and 7.9% of all hypertensive patients, according to our pooled analysis.