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Cardiovascular and renal complications in patients with resistant hypertension
Elizabeth S Muxfeldt1, Fabio de Souza, Victor S Margallo
1Department of Internal Medicine, University Hospital Clementino Fraga Filho, Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil, bethmux@globo.com.
Insights
Resistant hypertension significantly increases cardiovascular events and mortality. Early intervention is crucial to prevent organ damage and improve outcomes for patients with this condition.
Area of Science:
- Cardiology
- Nephrology
- Hypertension Research
Background:
- Resistant hypertension is increasingly prevalent, associated with high cardiovascular morbidity and mortality.
- Patients with resistant hypertension exhibit higher rates of cardiovascular events compared to non-resistant cases.
- Subclinical cardiovascular and renal damage, including left ventricular hypertrophy and microalbuminuria, is more common in resistant hypertension.
Purpose of the Study:
- To highlight the significant cardiovascular risks associated with resistant hypertension.
- To emphasize the link between organ damage and resistant hypertension.
- To advocate for comprehensive management strategies to prevent complications.
Main Methods:
- Analysis of a large patient cohort with resistant hypertension.
- Calculation of incidence rates for cardiovascular events and mortality.
- Comparison of event rates and organ damage prevalence between resistant and non-resistant hypertensive patients.
Main Results:
- Crude incidence rate of total cardiovascular events was 4.32 per 100 patient-years (19.6%).
- Cardiovascular mortality rate was 8.3% (1.72 per 100 patient-years).
- Resistant hypertensives showed higher cardiovascular event rates (18.0% vs 13.5%) and greater prevalence of organ damage.
Conclusions:
- Resistant hypertension poses a substantial threat, necessitating aggressive blood pressure control.
- Preventing and reversing subclinical cardiovascular and renal damage is key to improving prognosis.
- Focus on preventing cardiovascular and renal complications is paramount for better patient outcomes.
Abstract:
With an increased prevalence, resistant hypertension is recognized as an entity with a high cardiovascular morbidity and mortality. In a large cohort of patients with resistant hypertension, the crude incidence rate of total cardiovascular events reached 4.32 per 100 patient-years of follow-up (19.6 %), with a cardiovascular mortality of 8.3 % (incidence rate of 1.72 per 100 patient-years). Cardiovascular event rates are significantly higher in resistant hypertensives compared with non-resistant (18.0 % versus 13.5 %). In the same way, the prevalence of established cardiovascular and renal disease, as the asymptomatic organ damage (represented by left ventricular hypertrophy, carotid wall thickening, arterial stiffness, and microalbuminuria) is higher in these patients. Many studies have demonstrated a strong association between damage to these organs with higher blood pressure levels, the diagnosis of true resistant hypertension, and refractory hypertension. All efforts should be employed in order to control blood pressure and also to regress and/or prevent subclinical cardiovascular and renal damage. The focus should be on prevention of cardiovascular and renal complications, improving the prognosis of resistant hypertension.
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