Treatment efficiency of resistant hypertension in cardiologist's office

Abstract

Background: The target values of blood pressure have not been achieved in our population of patients sufficiently. The most difficult is a control of patients with resistant hypertension. We do not have data about efficiency treatment of these patients today. Objectives: The aim of our study was to assess current treatment status and by antihypertensive treatment modification we tried to reach an adequate blood pressure control. Methods: Fifty two patients suffering from resistant hypertension 2-3 degree ESC/ESH with high cardiovascular risk have been observed. Reaching of the target blood pressure values was verified by 24-hour ambulatory blood pressure monitoring. Results: The target blood pressure values were achieved in 50% of patients during 18 months. We noticed a statistically significant difference (p<0.001) in a decrease of casual and 24-hour ambulatory blood pressure in the group of controlled hypertensive patients in comparison with a group where blood pressure did not decrease sufficiently. In case of 50% patients, the target blood pressure values have not been reached in spite of more antihypertensive drugs and a higher dose. Conclusion: Adequately and systematically controlled patients were treated less intensively in comparison with an inadequately controlled group. 24-hour blood pressure monitoring analysis confirmed correction of the patological diurnal rhythm mostly in adequate blood pressure controlled group. In this group, we have noticed a statistically significant decrease of blood urea and creatinin levels and albumin/creatinin ratio in urine. Resistant hypertension needs multi-faceted approach with consistent control of all comorbidities in a case of problematic blood pressure control (Tab. 6, Fig. 1, Ref. 21).