Controlled Versus Uncontrolled Resistant Hypertension: Are They in the Same Bag?

Area of Science:

• Cardiology
• Nephrology
• Internal Medicine

Background:

• Resistant hypertension (RHTN) affects patients despite treatment with multiple antihypertensive drugs.
• RHTN management is complex due to diverse clinical presentations and underlying pathophysiology.
• Understanding RHTN subtypes is crucial for effective patient management and risk stratification.

Purpose of the Study:

• To categorize resistant hypertension into distinct clinical phenotypes.
• To explore the pathophysiological mechanisms driving different RHTN subtypes.
• To analyze risk factors, prognosis, and target organ damage in RHTN.

Main Methods:

• Classification of RHTN into controlled (C-RHTN) and uncontrolled (UC-RHTN) groups, including refractory hypertension (RfHTN).
• Review of pathophysiological mechanisms such as increased volemia, hyperactivity, and inflammatory factors.
• Analysis of clinical features including ethnicity, obesity, age, left ventricular hypertrophy, and vascular stiffness.

Main Results:

• RHTN is divided into C-RHTN and UC-RHTN, with RfHTN as a subgroup of UC-RHTN.
• Key pathophysiological factors include volemia, hyperactivity, cortisol, adipocitokines, and pro-inflammatory markers.
• Risk factors for refractoriness and poor prognosis include African ethnicity, obesity, age >60, LV hypertrophy, and vascular stiffness.

Conclusions:

• Controlled and uncontrolled resistant hypertension represent distinct phenotypes with differing mechanisms and clinical expressions.
• These differences necessitate tailored approaches to managing C-RHTN and UC-RHTN.
• Recognizing distinct RHTN subtypes is vital for improving cardiovascular outcomes and reducing target organ damage.