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Is resistant hypertension really resistant?

M A Brown1, M L Buddle, A Martin

  • 1Department of Renal Medicine, St George Hospital and University of NSW Kogarah, Sydney, Australia. mbrown@unsw.edu.au

American Journal of Hypertension
|January 5, 2002
PubMed
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Approximately 25% of patients with resistant hypertension actually have controlled blood pressure (BP), often due to the white-coat phenomenon. Ambulatory blood pressure monitoring (ABPM) is recommended before further investigation or treatment for apparent resistant hypertension.

Area of Science:

  • Cardiology
  • Hypertension Management
  • Diagnostic Tools

Background:

  • Resistant hypertension management is challenging, often necessitating costly tests for secondary causes.
  • The white-coat phenomenon can complicate accurate hypertension diagnosis and management.
  • 24-hour ambulatory blood pressure monitoring (ABPM) offers a potential solution for clarifying BP control.

Purpose of the Study:

  • To determine the prevalence of the white-coat phenomenon in patients with resistant hypertension.
  • To assess if ABPM or nurse-recorded BP can identify patients with controlled BP among those with apparent resistant hypertension.

Main Methods:

  • 611 patients with elevated BP (≥140/90 mm Hg) were referred for 24-h ABPM.
  • Patients were categorized into three groups based on antihypertensive medication use.

Related Experiment Videos

  • Blood pressure was recorded by nurses before ABPM; controlled BP was defined as awake ambulatory BP <135/85 mm Hg.

    • Main Results:

    • 28% of resistant hypertensives and 32% of those on no antihypertensives had normal awake ambulatory BP.
    • The white-coat effect was significantly greater when BP was recorded by the referring doctor compared to a nurse.
    • Nurse-recorded BP showed high sensitivity (97%) but low specificity (57%) for identifying awake hypertension.

    Conclusions:

    • Roughly one in four patients with apparent resistant hypertension have controlled BP.
    • A significant proportion of patients referred for hypertension evaluation exhibit white-coat hypertension, identified by ABPM.
    • 24-hour ABPM is a valuable initial step for patients with seemingly resistant hypertension before further interventions.