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Factors prognostic of progression from resistant to refractory hypertension

09 Dec 2019

In patients with resistant hypertension, the risk of progression to refractory hypertension is associated with the presence of untreated obstructive sleep apnoea, glycated haemoglobin (HbA1c) concentration, initial heart rate and time since hypertension diagnosis, a study reports.

The study included 172 patients with confirmed resistant hypertension who underwent a 24-hour ambulatory blood pressure monitoring (ABPM) study at the end of the follow-up. All patients also underwent a sleep study.

After a mean follow up of 57 months, 30 patients (17.4 percent; mean age, 59.1 years; 64 percent male) who initially satisfied the criteria for resistant hypertension progressed to refractory hypertension. This was despite the prescription of a greater number of long-acting thiazide-like diuretics and mineralocorticoid receptor antagonists.

On multivariate analysis, the risk of progression from resistant to refractory hypertension was associated with the following factors: poor adherence to continuous positive airway pressure (CPAP) in cases of obstructive sleep apnoea (odds ratio [OR], 3.36, 95 percent confidence interval [CI], 1.47–7.7; p=0.004), HbA1c concentration (OR, 1.42, 95 percent CI, 1.42–1.8; p=0.005), longer period since the diagnosis of resistant hypertension (OR, 1.06, 95 percent CI, 1.01–1.1; p=0.007) and initial heart rate (OR, 1.05, 95 percent CI, 1.01–1.09; p=0.004).

According to researchers, the present data may be of use to clinicians managing patients with resistant hypertension, as it could contribute to an earlier identification of those patients susceptible to progressing to a refractory condition (through anticipatory measures such as close monitoring of diabetes, a sleep study for all patients and CPAP treatment whenever necessary), over and above any required changes in lifestyle or medication.

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Most Read Articles
01 Nov 2019
Women with hypertensive disorders of pregnancy, especially pre-eclampsia, are at heightened risk of developing cardiovascular disorder and chronic hypertension, with the risk becoming apparent soon after pregnancy, a study has found.
Roshini Claire Anthony, 29 May 2019

Gestational diabetes and abnormal glucose levels in pregnancy, as determined with an oral glucose challenge test (OGCT) at 24–28 weeks gestation, could signal a future risk of cardiovascular disease (CVD)*, according to a recent study.

07 Jul 2019
Plasma creatinine kinase activity, measure during early pregnancy, influences blood pressure during pregnancy and contributes to severe gestational hypertension diagnosed before 34 weeks of gestation, according to a recent study. There is no association between creatinine kinase and other hypertensive disorders during pregnancy.
Pank Jit Sin, 16 Oct 2019
While a diagnosis of cancer is often met with concern and devastation, the same is barely true for heart failure. However, the mortality rate for those suffering from heart failure is worse than some common cancers, such as prostate and breast cancers.