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|Title:||True resistant hypertension : definition and prevalence|
Calhoun, David A.
|Abstract:||The characterization of patients with resistant hypertension (RHT) is a frequent clinical problem and at least in part because its definition is not consistent worldwide. We have read with great interest the article by de la Sierra et al. showing a very high prevalence of RHT. Obesity, longer hypertension duration and cardiac and kidney damage were strongly associated with the clinical condition, although it is difficult to ascertain if they were uncontrolled despite treatment with three drugs or true resistant hypertensive patients. Also, the article emphasizes that ambulatory blood pressure monitoring (ABPM) may reveal white coat and masked hypertension in the studied population. However, 14.5% patients of the total cohort included in the Spanish ABPM Registry were classified as having RHT, which seems especially high for a cohort of patients attended mainly by general practitioners. In fact, data derived from outcome studies including the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) , Valsartan Antihypertensive Long-term Use Evaluation (VALUE)  and Controlled Onset Verapamil Investigation of Cardiovascular End Points (CONVINCE)  indicate that this condition may be more common than previously thought . However, these estimates do not completely account for uncontrolled hypertension secondary to undertreatment and poor adherence. We would like to note that the real prevalence of RHT may be much lower and, at least in part, this mistake is due to inconsistencies in defining RHT and the lack of strict criteria for inclusion in the registry and the absence of quality control of the data. For instance, in the present article, de la Sierra et al. use as definition for RHT “blood pressure (BP) that remains elevated despite of three concomitant antihypertensive drugs” as partially defined by Calhoun et al.[6,7] a few years ago. In this case, a second set of RHT patients defined as those “whose blood pressure is controlled requiring four or more classes of antihypertensive drugs” was not taken into account. Of course, the inclusion of these patients would increase the proportion of RHT individuals in this study, but also proper adherence, use of optimal dosage and nonpharmacological treatment were not analyzed in this population, which would reduce drastically the observed prevalence|
|Editor:||Lippincott Williams & Wilkins|
|Appears in Collections:||FCM - Artigos e Outros Documentos|
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