Abstract 5854: Prevalence of Truly Resistant Hypertension Prospectively Evaluated in a Clinical Setting
Background: in face of variable definitions and sampling criteria, the real prevalence of resistant hypertension in a clinical setting is unknown.
Methods: this is a prospectively planned investigation of the prevalence of truly resistant hypertension in an outpatient hypertension clinic. Truly resistant hypertension was diagnosed when other reasons for uncontrolled blood pressure (BP ≥ 140/90 mmHg) in patients using a rational combination of three blood pressure-lowering agents, including a diuretic, were excluded: lack of compliance, secondary hypertension and use of other drugs.
Results: In the total, 606 patients, with 35 to 65 years of age, mostly women, with BP of 156.6±24.4 mmHg by 92.9±14.7 mmHg and a BMI of 29.8±5.8 Kg/m2 were sequentially evaluated. One hundred and six had uncontrolled blood pressure (17.5% of the whole sample) despite the use of rational therapy with at least three drugs. These patients were submitted to an Ambulatory Blood Pressure monitoring, were oriented to follow the medical prescription and asked to return for confirmation. Patients who still did not have investigation for secondary hypertension were investigated as necessary. Eighty six patients (81% of the patients with uncontrolled blood pressure in the first evaluation) returned for the confirmatory evaluation. Twenty five had controlled blood pressure in this consultation, 21 had evidence of low adherence to treatment, 13 had white coat phenomenon and 9 had secondary hypertension, leaving only 18 patients (18% of those uncontrolled in the first moment and 3% of the whole sample) with truly resistant hypertension. Including patients with secondary hypertension, the prevalence of resistant hypertension was of 4.4%.
Conclusion: truly resistant hypertension, not explained by low compliance or secondary causes, is infrequent in outpatient clinics for patients with hypertension, and it is not substantially increased with the inclusion of patients with secondary hypertension.