Factors associated with the changes from a resistant to a refractory phenotype in hypertensive patients: a Pragmatic Longitudinal Study.

Fecha de publicación: 01/11/2019 Fecha Ahead of Print: 17/06/2019

Autores de IIS La Fe

Cristina Navarro Soriano

Autor
Miguel Ángel Martínez García

Autor
Grace Jacqueline Oscullo Yépez

Autor
Laura Feced Olmos

Autor
Alberto García Ortega

Autor

Participantes ajenos a IIS La Fe

Torres G
Barbé F
Caballero-Eraso C
Lloberes P
Cambriles TD
Somoza M
Masa JF
González M
Mañas E
de la Peña M
García-Río F
Montserrat JM
Muriel A
Calhoun D
Campos-Rodriguez F
Spanish Sleep Network

Grupos

Neumología

Leader

Miguel Ángel Martínez García

Abstract

Refractory hypertension (RfH) is defined as a lack of blood pressure control despite the administration of at least 5 anti-hypertensive drugs. The factors associated with its natural history are unknown. This study aimed to evaluate both the incidence of RfH in an cohort of patients with resistant hypertension (RH) and the factors involved in that progression. This was an observational prospective multicenter study (24 centers) with 172 patients with confirmed RH (24-h ABPM) who underwent a further 24 h ABPM study at the end of the follow-up. Prospective information was obtained from all patients in their corresponding Hypertension Units via a standard clinical protocol, and they all underwent a sleep study. Thirty patients were diagnosed with RfH (17.4%) after a mean follow-up of 57 months, despite the prescription of a greater number of long-acting thiazide-like diuretics and mineralocorticoid receptor antagonists. The factors associated with progression to RfH were: a longer period since the diagnosis of RH (OR: 1.06, 95% CI: 1.01-1.1, p = 0.007); the HbA1c concentration (OR: 1.42, 95% CI: 1.42-1.8; p = 0.005); the initial heart rate (OR: 1.05, 95% CI: 1.01-1.09, p = 0.004); and poor adherence to continuous positive airway pressure (CPAP) in cases of obstructive sleep apnea (OR: 3.36, 95% CI: 1.47-7.7, p = 0.004). In conclusion, a considerable percentage of patients evolved from the RH to the RfH phenotype despite changes in their treatment. Some easily measurable variables, such as heart rate, the time since the diagnosis, the HbA1c level, and the presence of untreated obstructive sleep apnea (or poor adherence to CPAP) have been demonstrated to be prognostic factors in the progression to RfH.

Datos de la publicación

ISSN/ISSNe:: 0916-9636, 1348-4214
Tipo:: Article
Páginas:: 1708-1715
DOI:: 10.1038/s41440-019-0285-8
Factor de Impacto:: 0,885 SCImago ℠
Cuartil:: Q2 SCImago ℠

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Métricas

Filiaciones

Navarro-Soriano C:: Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
Martínez-García MA:: Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
Torres G:: Internal Medicine Service, Hospital Universitari Arnau de Vilanova, Lleida, Spain
Barbé F:: Institut de Recerca Biomédica, IRB Lleida, Spain

CIBERes, CIBER de enfermedades Respiratorias, Madrid, Spain
Caballero-Eraso C:: CIBERes, CIBER de enfermedades Respiratorias, Madrid, Spain

Respiratory Department, Hospital Universitario Virgen del Rocío. Institute of Biomedicine of Seville (IBiS), Seville, Spain
Lloberes P:: Respiratory Department, Hospital Universitario Vall Hebrón, Barcelona, Spain
Cambriles TD:: Respiratory Department, Hospital Universitario 12 de Octubre, Madrid, Spain
Somoza M:: Respiratory Department, Consorcio Sanitario de Terrassa, Barcelona, Spain
Masa JF:: Respiratory Department, Hospital Universitario San Pedro de Alcántara, Cáceres, Spain
González M:: Respiratory Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
Mañas E:: Respiratory Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
de la Peña M:: Respiratory Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain
García-Río F:: CIBERes, CIBER de enfermedades Respiratorias, Madrid, Spain

Respiratory Department, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
Montserrat JM:: CIBERes, CIBER de enfermedades Respiratorias, Madrid, Spain

Respiratory Department, Hospital Clinic-IDIBAPS, Barcelona, Spain
Muriel A:: Biostatistic Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
Oscullo G:: Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
Olmos LF:: Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
García-Ortega A:: Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
Calhoun D:: Vascular Department, University of Alabama, Tuscaloosa, USA
Campos-Rodriguez F:: CIBERes, CIBER de enfermedades Respiratorias, Madrid, Spain

Respiratory Department, Hospital Universitario Valme, Institute of Biomedicine of Seville (IBiS), Sevilla, Spain