The prevalence of resistant and undercontrolled hypertension among patients of a Hypertension Outpatient Clinic
Abstract
Introduction. Around 57% of Hungarian hypertensive patients did not reach the goal blood pressure. According to an ESH Newsletter published in 2011, the prevalence of resistant hypertension is 2.9–43%.
Objective. Analysing only the therapy of hypertensive patients of the Hypertension Outpatient Clinic of the University of Szeged, the authors wanted to answer following main questions: How many patients were therapeutically resistant according to the definition of resistant hypertension? How many patients were taking 3 or more antihypertensive drugs? How many of these patients reached target SBP values? How many drugs were usually used in combination therapy?
Material and methods. Data were retrospectively collected from 01/01/2011 to 31/08/2011 from the electronic files of the hypertensive patients. Altogether 310 patients’ data were analysed, of all cases only one visit was taken into account. For those patients who visited the Clinic more than once during this period, only the first visit was considered. Means of two measurements were calculated. The goal SBP was 140 mmHg.
Results. In this population, 234/310 (76%) patients had resistant hypertension according to the definition (158 ± 17/97 ± 8 mmHg). Three or more antihypertensive drugs were taken by 257/310 (83%) patients (136 ± 20 mmHg) and 134 of them (52% of 257 patients) reached the therapeutic goal. A fourfold combination of antihypertensive agents was the most frequent in this population.
Conclusion. It is advised to use multiple drug combinations and it is recommended to spend enough time but not longer than necessary to find the most effective combination in every case.
Keywords: resistanthypertensioncombination
References
- Szegedi J, Kékes E, Sonkodi S, et al. A hypertonia epidemiológiája Magyarországon. Hypertonia és Nephrologia. 2014; 18(5-6): 134–143.
- Kékes E, Kiss I, Pál L. A magyar hipertóniás populáció gyógyszeres kezelésének gyakorlata négy év távlatában (2005-2009). Háziorv Továbbk Szle. 2010; 15(9): 594–599.
- Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension The Task Force for the management ofarterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013; 31: 1281–1357.
- Calhoun DA, Jones D, Textor S, et al. Resistant Hypertension: Diagnosis, Evaluation, and Treatment: A Scientific Statement From the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation. 2008; 117(25): e510–e526.
- Viera AJ. Resistant Hypertension. J Am Board Fam Med. 2012; 25(4): 487–495.
- Mancia G, De Backer G, Dominiczak A, et al. 2007 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). J Hypertens. 2007; 25(6): 1105–1187.
- Garg JP, Elliott WJ, Folker A, et al. RUSH University Hypertension Service. Resistant hypertension revisited: a comparison of two university-based cohorts. Am J Hypertens. 2005; 18(5 Pt 1): 619–626.
- Erdine S, Arslan E, Coca A. Resistant hypertension. European Society of Hypertension Scientific Newsletter: Update on Hypertension Management. 2011; 12(15).
- Mancia G, Laurent S, Agabiti-Rosei E, et al. European Society of Hypertension. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens. 2009; 27(11): 2121–2158.
- Cuspidi C, Macca G, Sampieri L, et al. High prevalence of cardiac and extracardiac target organ damage in refractory hypertension. J Hypertens. 2001; 19(11): 2063–2070.
- Isaksson H, Ostergren J. Prognosis in therapy-resistant hypertension. J Intern Med. 1994; 236(6): 643–649.
- Kékes E, Schanberg Zs, Kiss I. Hogyan értékeljük társadalmi szinten a magas vérnyomás kezelését az ˝Éljen 140/90 alatt" mozgalom keretében? Hypertonia és Nephrológia. 2007; 11: 232–236.
- Kiss I, Kékes E. A hypertoniás betegek célvérnyomás-elérési arányának és gondozási minőségének segítése telemedicinális lehetőségek alkalmazásával. Hypertonia és Nephrologia. 2012; 16(6): 243–245.
- Ábrahám Gy. Az ajánlások érvényesülése a hazai magasvérnyomás-betegek kezelésében: a HERCULES (Hungarian HypERtensive Patients' Treatment in line with CUrrent Therapeutical GuideLine Study) vizsgálat első eredményei. Háziorv Továbbk Szle. 2012; 17(7): 420–425.
- Gonzalez-Santos L, Elliott WJ, Setaro JF. Resistant hypertension. In: Black HR, Elliott WJ. ed. Hypertension. A Companion to Braunwald’s Heart Disease. 2nd edition. Elsevier Saunders 2012: 378–384.