Cardiovascular Risk Area, Internal Medicine Department, Hospital Moisès Broggi Sant Joan Despi, University of Barcelona, Spain
Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, AL.
J Am Heart Assoc. 2017 Dec 7;6(12):e007365. doi: 10.1161/JAHA.117.007365.
We aimed to estimate the prevalence of refractory hypertension (RfH) and to determine the clinical differences between these patients and resistant hypertensives (RH). Secondly, we assessed the prevalence of white-coat RfH and clinical differences between true- and white-coat RfH patients.
The present analysis was conducted on the Spanish Ambulatory Blood Pressure Monitoring Registry database containing 70 997 treated hypertensive patients. RH and RfH were defined by the presence of elevated office blood pressure (≥140 and/or 90 mm Hg) in patients treated with at least 3 (RH) and 5 (RfH) antihypertensive drugs. White-coat RfH was defined by RfH with normal (<130/80 mm Hg) 24-hour blood pressure. A total of 11.972 (16.9%) patients fulfilled the standard criteria of RH, and 955 (1.4%) were considered as having RfH. Compared with RH patients, those with RfH were younger, more frequently male, and after adjusting for age and sex, had increased prevalence of target organ damage, and previous cardiovascular disease. The prevalence of white coat RfH was lower than white-coat RH (26.7% versus 37.1%, <0.001). White-coat RfH, in comparison with those with true RfH, showed a lower prevalence of both left ventricular hypertrophy (22% versus 29.7%; =0.018) and microalbuminuria (28.3% versus 42.9%; =0.047).
The prevalence of RfH was low and these patients had a greater cardiovascular risk profile compared with RH. One out of 4 patients with RfH have normal 24-hour blood pressure and less target organ damage, thus indicating the important role of ambulatory blood pressure monitoring in guiding antihypertensive therapy in difficult-to-treat patients.
本研究旨在评估难治性高血压（RfH）的患病率，并确定这些患者与抵抗性高血压（RH）之间的临床差异。其次，我们评估了白大衣难治性高血压（white-coat RfH）的患病率以及真正的和白大衣 RfH 患者之间的临床差异。
本分析基于包含 70997 例高血压患者的西班牙动态血压监测登记数据库进行。RH 和 RfH 的定义是：接受至少 3（RH）和 5（RfH）种降压药物治疗的患者，诊室血压升高（≥140 和/或 90mmHg）。白大衣 RfH 的定义是 RfH 伴有正常（<130/80mmHg）24 小时血压。共有 11972 例（16.9%）患者符合 RH 的标准标准，955 例（1.4%）被认为患有 RfH。与 RH 患者相比，RfH 患者年龄较小，男性更为常见，在调整年龄和性别后，靶器官损伤和既往心血管疾病的患病率更高。白大衣 RfH 的患病率低于白大衣 RH（26.7%对 37.1%，<0.001）。与真正的 RfH 患者相比，白大衣 RfH 患者的左心室肥厚（22%对 29.7%，=0.018）和微量白蛋白尿（28.3%对 42.9%，=0.047）的患病率较低。
RfH 的患病率较低，与 RH 患者相比，这些患者的心血管风险更高。在 RfH 患者中，有 1/4 的患者 24 小时血压正常，靶器官损伤较少，这表明动态血压监测在指导难治性高血压患者的降压治疗方面具有重要作用。
