Factors prognostic of progression from resistant to refractory hypertension

In patients with resistant hypertension, the risk of progression to refractory hypertension is associated with the presence of untreated obstructive sleep apnoea, glycated haemoglobin (HbA1c) concentration, initial heart rate and time since hypertension diagnosis, a study reports.

The study included 172 patients with confirmed resistant hypertension who underwent a 24-hour ambulatory blood pressure monitoring (ABPM) study at the end of the follow-up. All patients also underwent a sleep study.

After a mean follow up of 57 months, 30 patients (17.4 percent; mean age, 59.1 years; 64 percent male) who initially satisfied the criteria for resistant hypertension progressed to refractory hypertension. This was despite the prescription of a greater number of long-acting thiazide-like diuretics and mineralocorticoid receptor antagonists.

On multivariate analysis, the risk of progression from resistant to refractory hypertension was associated with the following factors: poor adherence to continuous positive airway pressure (CPAP) in cases of obstructive sleep apnoea (odds ratio [OR], 3.36, 95 percent confidence interval [CI], 1.47–7.7; p=0.004), HbA1c concentration (OR, 1.42, 95 percent CI, 1.42–1.8; p=0.005), longer period since the diagnosis of resistant hypertension (OR, 1.06, 95 percent CI, 1.01–1.1; p=0.007) and initial heart rate (OR, 1.05, 95 percent CI, 1.01–1.09; p=0.004).

According to researchers, the present data may be of use to clinicians managing patients with resistant hypertension, as it could contribute to an earlier identification of those patients susceptible to progressing to a refractory condition (through anticipatory measures such as close monitoring of diabetes, a sleep study for all patients and CPAP treatment whenever necessary), over and above any required changes in lifestyle or medication.