Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA.
Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA.
J Clin Hypertens (Greenwich). 2020 Feb;22(2):167-173. doi: 10.1111/jch.13826. Epub 2020 Feb 12.
The purpose of the current study was to determine whether aortic blood pressure (BP) and arterial stiffness are greater in patients with controlled resistant hypertension (RHTN) than controlled non-resistant hypertension (non-RHTN) despite similar clinic BP level. Participants were recruited from University of Alabama at Birmingham (UAB) Hypertension Clinic. Controlled hypertension was defined as automated office BP measurement with BP < 135/85 mm Hg. A total of 141 participants were evaluated by pulse wave analysis (PWA) and carotid-femoral pulse wave velocity (cf-PWV). Among them, 75 patients had controlled RHTN with use of 4 or more antihypertensive medications and 56 patients had controlled non-RHTN with use of 3 or less antihypertensive medications. Compared to patients with controlled non-RHTN, those with controlled RHTN were more likely to be African American and had a higher prevalence of diabetes mellitus and congestive heart failure. The mean number of antihypertensive medications was greater in patients with controlled RHTN (4.4 ± 0.8 vs 2.3 ± 0.7, P < .001). Clinic brachial BP, aortic BP, augmentation pressure (AP), augmentation index normalized for heart rate of 75 beats per minute (AIx@75) and cf-PWV were similar in both groups. In summary, there was no significant difference in central BP or arterial stiffness between patients with controlled RHTN and controlled non-RHTN. These findings suggest that the higher residual cardiovascular risk observed in patients with RHTN after achieving BP control compared to patients with more easily controlled hypertension is not likely attributable to persistent differences in central BP and arterial stiffness.
本研究旨在确定，在诊室血压（BP）水平相似的情况下，与血压得到控制的非耐药性高血压（non-RHTN）患者相比，血压得到控制的耐药性高血压（RHTN）患者的主动脉 BP 和动脉僵硬度是否更大。参与者是从阿拉巴马大学伯明翰分校（UAB）高血压诊所招募的。血压得到控制的高血压定义为自动诊室 BP 测量值<135/85mmHg。共有 141 名参与者接受了脉搏波分析（PWA）和颈股脉搏波速度（cf-PWV）评估。其中，75 名患者使用 4 种或更多种降压药物治疗耐药性 RHTN，56 名患者使用 3 种或更少种降压药物治疗非耐药性 RHTN。与血压得到控制的非耐药性高血压患者相比，血压得到控制的耐药性高血压患者更有可能为非裔美国人，且糖尿病和充血性心力衰竭的患病率更高。血压得到控制的 RHTN 患者使用的降压药物数量多于血压得到控制的非耐药性高血压患者（4.4±0.8 比 2.3±0.7，P<0.001）。两组患者的诊室肱动脉 BP、主动脉 BP、增强压（AP）、心率为 75 次/分时的增强指数归一化值（AIx@75）和 cf-PWV 相似。总之，血压得到控制的 RHTN 患者与血压得到控制的非耐药性高血压患者之间的中心 BP 或动脉僵硬度没有显著差异。这些发现表明，与更容易控制的高血压患者相比，血压得到控制的 RHTN 患者的残余心血管风险较高，这可能不是由于中心 BP 和动脉僵硬度持续存在差异所致。
