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RESEARCH PRODUCT

Improving Knowledge of Arterial Resistant Hypertension: What Is Relevant?

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Resistant hypertension, also known as refractory hypertension in the literature, is a relatively common disease that is associated with elevated cardiovascular and renal risk. Clinical trials suggest that its prevalence is around 35% in hypertensive patients with a baseline blood pressure (BP) > 160/100 mmHg. However, data obtained from registries or from the physician’s office suggest that its prevalence is around 12%. The recent National Health and Nutrition Examination Survey suggests a similar prevalence of 12.3% in diagnosed and treated hypertensive patients. An incidence study conducted at Kaiser Permanente Colorado and Kaiser Permanente Northern California followed up more than 200 000 hypertensive patients who started antihypertensive therapy. Of these, 0.7/100 patients/year developed resistance to treatment. Furthermore, this study showed that the risk of cardiovascular events was 47% higher in the resistant patients than in the other patients during a mean follow-up of more than 3 years. Although its definition has undergone changes in the last 30 years, currently the concept applies to patients undergoing antihypertensive treatment with a combination of 3 or more antihypertensive agents at optimal doses, 1 of which must be a diuretic, with BP remaining above the goal of 140 mmHg and/or 90 mmHg. A new definition of resistant hypertension refers to patients who require treatment with 4 or more drugs to achieve BP control. This definition is based on epidemiological studies, but is of little clinical use. Regardless of its prevalence and definitions, the recent interest in this condition in the medical literature is striking, given that patients with drug-resistant hypertension have always been seen in hypertension units. There has been an increase in the number of publications in PubMed in which the descriptors ‘‘resistant hypertension’’ or ‘‘refractory hypertension’’ appear in the title or abstract (Figure). From an average of 10 articles published per year up to 2008, the number grew to 200 articles published in 2012, and reached a total of 325 articles published in 2013 (as of November 15). The reason for this sudden interest is doubtless associated with the introduction of new procedures for the control of hypertension in these patients, involving nonpharmacological intervention techniques applied to the adrenergic nervous system,