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Vol 24, No 1 (2020)
ORIGINAL PAPERS
Published online: 2020-01-24
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Features of hemodynamic and metabolic disorders in obese patients with resistant hypertension

Anna Shalimova, Valentyna Psarova, Maryna Kochuieva, Olena Kolesnikova, Anna Isayeva, Vira Zlatkina, Valeriya Nemtsova
DOI: 10.5603/AH.a2020.0002
·
Arterial Hypertension 2020;24(1):22-29.

open access

Vol 24, No 1 (2020)
ORIGINAL PAPERS
Published online: 2020-01-24

Abstract

Background. The aim was to establish the features of hemodynamic and metabolic parameters in obese patients with true and pseudo-resistant arterial hypertension (AH).

Material and methods. The study included 200 patients with uncontrolled AH and obesity. Patients were initially prescribed dual antihypertensive therapy. Those patients who did not reach target blood pressure (BP) levels after 3 months on dual therapy were additionally prescribed a third antihypertensive drug. Of the 98 patients who were assigned to triple therapy, 48 patients did not reach target BP (27 patients had pseudo-resistant and 21 patients had true resistant AH). These patients were additionally prescribed a fourth antihypertensive drug (spironolactone). The effectiveness of the treatment was evaluated 6 months after the start of antihypertensive therapy.

Results. After 6 months of therapy, unlike patients without resistance, individuals with resistant AH had more pronounced cardiovascular remodeling and metabolic disorders, disbalance of oxidative stress-antioxidant protection, proinflammatory activity and higher activity of the renin-angiotensin-aldosterone system. Patients with true resistance differed from pseudo-resistant patients by having significantly lower body mass index (BMI); in the absence of differences in BP levels, cardiovascular remodeling, lipid and carbohydrate profiles, patients with true resistance had significantly higher levels of aldosterone, higher activity of oxidative stress system, lower levels of general antioxidant protection, higher adiponectin levels, and lower leptin level.

Conclusions. Obese patients with true resistance differed from pseudo-resistant patients by having significantly lower BMI, higher aldosterone levels, more pronounced imbalance of the system of oxidative stress-antioxidant protection and less pronounced adipokine imbalance.

Abstract

Background. The aim was to establish the features of hemodynamic and metabolic parameters in obese patients with true and pseudo-resistant arterial hypertension (AH).

Material and methods. The study included 200 patients with uncontrolled AH and obesity. Patients were initially prescribed dual antihypertensive therapy. Those patients who did not reach target blood pressure (BP) levels after 3 months on dual therapy were additionally prescribed a third antihypertensive drug. Of the 98 patients who were assigned to triple therapy, 48 patients did not reach target BP (27 patients had pseudo-resistant and 21 patients had true resistant AH). These patients were additionally prescribed a fourth antihypertensive drug (spironolactone). The effectiveness of the treatment was evaluated 6 months after the start of antihypertensive therapy.

Results. After 6 months of therapy, unlike patients without resistance, individuals with resistant AH had more pronounced cardiovascular remodeling and metabolic disorders, disbalance of oxidative stress-antioxidant protection, proinflammatory activity and higher activity of the renin-angiotensin-aldosterone system. Patients with true resistance differed from pseudo-resistant patients by having significantly lower body mass index (BMI); in the absence of differences in BP levels, cardiovascular remodeling, lipid and carbohydrate profiles, patients with true resistance had significantly higher levels of aldosterone, higher activity of oxidative stress system, lower levels of general antioxidant protection, higher adiponectin levels, and lower leptin level.

Conclusions. Obese patients with true resistance differed from pseudo-resistant patients by having significantly lower BMI, higher aldosterone levels, more pronounced imbalance of the system of oxidative stress-antioxidant protection and less pronounced adipokine imbalance.

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Keywords

resistant hypertension; obesity; hemodynamic disorders; metabolic disorders

About this article
Title

Features of hemodynamic and metabolic disorders in obese patients with resistant hypertension

Journal

Arterial Hypertension

Issue

Vol 24, No 1 (2020)

Pages

22-29

Published online

2020-01-24

DOI

10.5603/AH.a2020.0002

Bibliographic record

Arterial Hypertension 2020;24(1):22-29.

Keywords

resistant hypertension
obesity
hemodynamic disorders
metabolic disorders

Authors

Anna Shalimova
Valentyna Psarova
Maryna Kochuieva
Olena Kolesnikova
Anna Isayeva
Vira Zlatkina
Valeriya Nemtsova

References (15)
  1. Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018; 39(33): 3021–3104.
  2. Chernova I, Krishnan N. Resistant Hypertension Updated Guidelines. Curr Cardiol Rep. 2019; 21(10): 117.
  3. Gorini S, Marzolla V, Mammi C, et al. Mineralocorticoid Receptor and Aldosterone-Related Biomarkers of End-Organ Damage in Cardiometabolic Disease. Biomolecules. 2018; 8(3).
  4. Ezequiel DG, Paula RB, Lovisi JC, et al. [Spironolactone reduces blood pressure and albuminuria of obese hypertensive patients with metabolic syndrome]. J Bras Nefrol. 2013; 35(1): 69–72.
  5. Hannich M, Wallaschofski H, Nauck M, et al. Physiological Aldosterone Concentrations Are Associated with Alterations of Lipid Metabolism: Observations from the General Population. Int J Endocrinol. 2018; 2018: 4128174.
  6. DuPont JJ, Jaffe IZ. 30 years of the mineralocorticoid receptor: The role of the mineralocorticoid receptor in the vasculature. J Endocrinol. 2017; 234(1): T67–T82.
  7. Wada T, Ishikawa A, Watanabe E, et al. Eplerenone prevented obesity-induced inflammasome activation and glucose intolerance. J Endocrinol. 2017; 235(3): 179–191.
  8. Min SeH, Kim SeH, Jeong InK, et al. Independent Association of Serum Aldosterone Level with Metabolic Syndrome and Insulin Resistance in Korean Adults. Korean Circ J. 2018; 48(3): 198–208.
  9. Ramalingam L, Menikdiwela K, LeMieux M, et al. The renin angiotensin system, oxidative stress and mitochondrial function in obesity and insulin resistance. Biochim Biophys Acta Mol Basis Dis. 2017; 1863(5): 1106–1114.
  10. Pizoń T, Rajzer M, Wojciechowska W, et al. The relationship between plasma renin activity and serum lipid profiles in patients with primary arterial hypertension. J Renin Angiotensin Aldosterone Syst. 2018; 19(4): 1470320318810022.
  11. Rossier BC, Staub O, Hummler E. Genetic dissection of sodium and potassium transport along the aldosterone-sensitive distal nephron: importance in the control of blood pressure and hypertension. FEBS Lett. 2013; 587(13): 1929–1941.
  12. Funder JW. Aldosterone and Mineralocorticoid Receptors-Physiology and Pathophysiology. Int J Mol Sci. 2017; 18(5).
  13. Luther JM. Effects of aldosterone on insulin sensitivity and secretion. Steroids. 2014; 91: 54–60.
  14. Tesch GH, Young MJ. Mineralocorticoid Receptor Signaling as a Therapeutic Target for Renal and Cardiac Fibrosis. Front Pharmacol. 2017; 8: 313.
  15. Kathiresan S, Larson MG, Benjamin EJ, et al. Clinical and genetic correlates of serum aldosterone in the community: the Framingham Heart Study. Am J Hypertens. 2005; 18(5 Pt 1): 657–665.

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