Etiology in resistant hypertension

Year 2024, , 232 - 239, 28.05.2024

Yaşar Culha , Özkan Gülmez , Banu İşbilen Başok , Ferruh Kemal İşman , Aytekin Oğuz

https://doi.org/10.38053/acmj.1455488

Abstract

Aims: Resistant hypertension is defined as blood pressure that remains above goal despite the concurrent use of 3 antihypertensive agents of different classes. In resistant hypertensive patients, revealing the cause of secondary hypertension may allow drug or surgical treatment for the correction of hypertension. Resistant hypertensive patients, a significant portion of the hypertensive population, is estimated to occur. We aimed to investigate general characteristics and factors that make it difficult to control blood pressure in resistant hypertensive patients and to identify the incidence of secondary hypertension and secondary hypertension causes that play a role in the etiology of resistant hypertension.
Methods: In the study, Turkish Republic Ministry of Health, İstanbul Medeniyet University Göztepe Training and Research Hospital Internal Medicine, Diabetes and Obesity clinic for any reason the applicant and resistant hypertension detected a total of 80 patients (32 men, 48 women, mean age: 62±10) were enrolled consecutively. The treatment characteristics of patients, as well as demographic, anthropometric, and biochemical data, were evaluated, and the cause of secondary hypertension and etiology distribution were determined.
Results: In resistant hypertensive patients, the frequency of secondary hypertension was 60% (men 71%, women 52%). The most common causes of secondary hypertension are primary hyperaldosteronism (45%), obstructive sleep apnea syndrome (15%), and thyroid disorders (11%), respectively. 40% of the cases were diabetic, and 77.7% obese. Left ventricular hypertrophy and proteinuria were the most frequently detected target organ damage (96% and 37.5%, respectively). The average salt consumption of 10.75 grams/day was observed (males 12.2 g/day for females 9.7 g/day). There was analgesic use in 41% of cases, and in 3 cases, cola intake.
Conclusion: Secondary hypertension was found to be 60% common. Compared to other studies in the literature, primary hyperaldosteronism and pheochromocytoma were more common causes of secondary hypertension, and the obstructive sleep apnea syndrome was lower than expected. Hypercortisolism is not detected, which can be considered a surprising finding.

Keywords

: resistant hypertension, etiology, secondary hypertension, primary hyperaldosteronism

Ethical Statement

makale son kısmına eklenmiştir

Supporting Institution

makale son kısmına eklenmiştir

References

• Calhoun DA, Jones D, Textor S, et al. Resistant hypertension: diagnosis, evaluation, and treatment. Hypertension. 2008;51(6): 1403-1419.
• Mansia G, De Backer G, Dominiczak A, et al. 2007 ESH-ESC guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Blood Press 2007;16(3):135-232.
• The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Major outcomes in high-risk hypertensive patients randomized to angio-tensin-converting enzyme inhibitor or calcium channel blocker vs. diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002;288(23):2981-2997.
• Cushman WC, Ford CE, Cutler JA, et al. Success and predictors of blood pressure control in diverse North American settings: the Antihypertensive and Lipid-Lowering and Treatment to Prevent Heart Attack Trial (ALLHAT). J Clin Hypertens. 2002;4(6):393-404.
• Lloyd-Jones DM, Evans JC, Larson MG, O’Donnell CJ, Rocella EJ, Levy D. Differential control of systolic and diastolic blood pressure: factors associated with lack of blood pressure control in the community. Hypertension. 2000;36(4):594-599.
• Winkelmayer WC, Stampfer MJ, Willett WC, Curhan GC. Habitual caffeine intake and the risk of hypertension in women. JAMA. 2005;294(18):2330-2335.
• Pimenta E, Gaddam KK, Oparil S. Mechanisms and treatment of resistant hypertension. J Clin Hypertension. 2008;10(3):239-244.
• Gök F, Demir ME. Diagnosis and treatment of monogenic hypertension in children: monogenic hypertension. J Eur Intern Med Professionals. 2024;2(1):31-39.
• Carey RM, Calhoun DA, Bakris GL,et al. American Heart Association Professional/Public Education and Publications Committee of the Council on Hypertension; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Genomic and Precision Medicine; Council on Peripheral Vascular Disease; Council on Quality of Care and Outcomes Research; and Stroke Council. Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association. Hypertension. 2018;72(5):e53-e90.
• Viera AJ. Resistant hypertension. J Am Board Fam Med. 2012; 25(4):487-495.
• Omura M, Saito J, Yamaguchi K, Kakuta Y, Nishikawa T. Prospective study on the prevalence of secondary hypertension among hypertensive patients visiting a general outpatient clinic in Japan. Hypertens Res. 2004;27(3):193-202.
• Pedrosa RP, Drager LF, Gonzaga CC, et al. Obstructive sleep apnea: the most common secondary cause of hypertension with resistant hypertension. Hypertension. 2011;58(5):811-817.
• Lamirault G, Artifoni M, Daniel M, Barber-Chamoux N, Nantes University Hospital Working Group On Hypertension. Resistant hypertension: novel insights. Curr Hypertens Rev. 2020;16(1):61-72.
• Mohler ER III. Peripheral arterial disease: identification and implications. Arch Intern Med. 2003;163(19):2306-2314.
• Chobanian AV, Bakris GL, Black HR, et al. the seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA. 2003; 289(19):2560-2572.
• Harding SM. Prediction formulae for sleep-disordered breathing. Curr Opin Pulm Med. 2001;7(6):381-385.
• Türkiye Endokrinoloji ve Metabolizma Derneği, Tiroid Çalışma Grubu. Tiroid Hastalıkları Tanı ve Tedavi Kılavuzu 2020. Türkiye Klinikleri: 2020. Available from: https://file.temd.org.tr/Uploads/publications/guides/documents/20200929134733-2020tbl_kilavuzf527c34496.pdf?a=1
• Funder JW, Carey RM, Fardella C, et al. Case detection, diagnosis and treatment of patient with primary aldosteronism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2008;93(9):3266-3281.
• Sawka AM, Jaeschke R, Singh RJ, Young WF Jr. A comparison of biochemical tests for pheochromocytoma: measurement of fractionated plasma metanephrines compared with the combination of 24-hour urinary metanephrines and catecholamines. J Clin Endocrinol Metab. 2003;88(2):553-558.
• Shivashankara VU, Shivalli S, Pai BH, et al. A comparative study of sonographic grading of renal parenchymal changes and estimated glomerular filtration rate (eGFR) using modified diet in renal disease formula. J Clin Diagn Res. 2016;10(2):TC09-TC11.
• Seiler L, Rump LC, Schulte-Mönting J, et al. Diagnosis of primary aldosteronism: value of different screening parameters and influence of antihypertensive medication. Eur J Endocrinol. 2004;150(3):329-337.
• Morillas P, Castillo J, Quiles J, et al. Prevalence of primary aldosteronism in hypertensive patients and its effect on the heart. Rev Esp Cardiol. 2008;61(4):418-421.
• Kumar N, Calhoun DA, Dudenbostel T. Management of patients with resistant hypertension: current treatment options. Integr Blood Press Control. 2013;6:139-151.
• Textor SC, Lerman L. Renovascular hypertension and ischemic nephropathy. Am J Hypertens. 2010;23(11):1159-1169.
• Renovascular Hypertension. In: Kaplan NM, Lieberman E, Neal WA. Kaplan’s Clinical Hypertension. 8th ed. Lippincott Williams & Wilkins: 2002:381-403.
• Logan AG, Perlikowski SM, Mente A, et al. High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J Hypertens. 2001;19(12):2271-2277.
• Force AHT. AACE Guidelines. Endocr Pract. 2006;12(2):193.
• Mulatero P, Rabbia F, Milan A, et al. Drug effects on aldosterone/plasma renin activity ratio in primary aldosteronism. Hypertension. 2002;40(6):897-902.
• Klein I, Ojamaa K. Thyroid hormone and the cardiovascular system. N Engl J Med. 2001;344(7):501-509.
• Khawaja Z, Wilcox CS. Role of the kidney in resistant hypertension. Int J Hypertens. 2011;2011:143471.
• Renovascular Hypertension. In: Massry SG, Glassock RJ, eds. Massry’s and Glassock’s Textbook of Nephrology. Williams&Wilkins: 2001:1159-1168.
• Ganguly A, Grim CE, Weinberger MH, Henry DP. Rapid cyclic fluctuations of blood pressure are associated with an adrenal pheochromocytoma. Hypertension. 1984;6(2 Pt 1):281-284.
• Lindholm J, Juul S, Jorgensen JO, et al. Incidence and late prognosis of Cushing’s syndrome: a population-based study. J Clin End Metab. 2001;86(1):117-123.
• Bramlage P, Pittrow D, Wittchen HU, et al HYDRA (Hypertension and Diabetes Risk Screening and Awareness) AJH. 2004; 17: 904-910.
• de la Sierra A, Segura J, Banegas JR, et al. Clinical features of 8295 patients with resistant hypertension classified on the basis of ABPM. Hypertension. 2011;57(5):898-902.
• Cutler JA, Follman D, Alexander PS. Randomized controlled trials of sodium reduction: an overview. Am J Clin Nutr. 1997; 65(Suppl 2):643-651.
• Otten J, Pitzi Helliwig J, Meyers LD. The dietary reference intakes: the essential guide to nutrient requirements. National Academies Press: 2006.
• Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42(6):1206-1252.