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[Hypertension refractory to treatment. Case-control study].

A Froment, J Rabatel, H Milon

    Archives Des Maladies Du Coeur Et Des Vaisseaux
    |October 1, 1984
    PubMed
    Summary
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    This study identified two types of refractory hypertension. Type A hypertension, characterized by very high blood pressure, showed significantly higher mortality compared to controls.

    Area of Science:

    • Cardiology
    • Hypertension Research

    Background:

    • Refractory hypertension poses a significant clinical challenge.
    • Understanding subtypes of refractory hypertension is crucial for risk stratification.

    Purpose of the Study:

    • To define and characterize two distinct types of refractory hypertension.
    • To compare the clinical presentation, treatment, and outcomes of these subtypes.

    Main Methods:

    • Analysis of a clinical population (n=1290) hospitalized between 1969-1976.
    • Follow-up re-examinations (n=343) over four years to calculate average blood pressure (BPfu).
    • Case-control studies to compare Type A (BPfu ≥ 200/120 mmHg) and Type B (BPfu ≥ 107.5% of initial BP) refractory hypertension with controls.

    Main Results:

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    • Type A cases presented with more severe initial hypertension and associated cardiac/retinal involvement.
    • Type A cases had a significantly higher mortality rate (36%) over 8.7 years compared to controls (18%, p<0.05).
    • Type B cases had lower initial blood pressure, received less treatment, and experienced more side effects.
    • Type B cases showed a non-significant trend towards higher mortality (25.6%) over 8.9 years compared to controls (20.5%).

    Conclusions:

    • Type A refractory hypertension is associated with worse prognosis and higher mortality.
    • Type B refractory hypertension may represent a distinct entity with different risk factors and outcomes.
    • Further research is needed to optimize management strategies for different refractory hypertension subtypes.