Key result
Tertiary work-up including directly observed therapy and 24-h ABPM revealed that 53 of 83 patients (63.9%) with apparent treatment-resistant hypertension did not have true TRH.
Why the study?
Does thorough medical investigation including directly observed therapy and 24-hour ambulatory blood pressure monitoring improve the identification of true treatment-resistant hypertension in patients with apparent TRH?
Cohort (n=83)
Does thorough medical investigation including directly observed therapy and 24-hour ambulatory blood pressure monitoring improve the identification of true treatment-resistant hypertension in patients with apparent TRH?
Almost two-thirds of patients referred for tertiary work-up of apparent treatment-resistant hypertension do not have true TRH, highlighting the critical need for directly observed therapy and 24-hour ambulatory blood pressure monitoring.
Thorough evaluation often rules out true TRH; supports observed therapy plus ABPM but leaves optimal pathway open.
OBJECTIVE: Treatment-resistant hypertension (TRH) has regained attention with development of new methods for treatment. However, the prevalence of TRH varies considerably from primary to secondary and tertiary care. We aimed to assess the prevalence of true TRH in a population of patients with apparent TRH in a university hospital setting of tertiary work-up and also investigate reasons for poor BP control and evaluate how work-up can be performed in general practice and secondary care. METHODS: In this cohort study, we characterize a study population from Oslo Renal Denervation (RDN) Study. Patients (n = 83) were referred for RDN from secondary care. All patients underwent thorough medical investigation and 24-h ambulatory blood pressure measurements (24ABPM) after directly observed therapy (DOT). We then assessed reasons for lack of BP control. RESULTS: Fifty-three of 83 patients did not have true TRH. Main reasons for non-TRH were poor drug adherence (32%), secondary hypertension (30%) and white coat hypertension (15%). Forty-seven percent achieved blood pressure control after DOT with subsequent 24ABPM. There were otherwise no statistically significant differences in patient characteristics between the true TRH and the non-TRH group. CONCLUSION: Despite being a highly selected cohort referred for tertiary work-up of apparent TRH, BP control was achieved or secondary causes were identified in almost two thirds of the patients. Thorough investigation according to guidelines and DOT with subsequent 24ABPM is needed in work-up of apparent TRH.
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Heimark et al. (2016) conducted a cohort in Apparent treatment-resistant hypertension (n=83). Tertiary work-up including directly observed therapy and 24-h ABPM was evaluated on Prevalence of true treatment-resistant hypertension. Tertiary work-up including directly observed therapy and 24-h ABPM revealed that 53 of 83 patients (63.9%) with apparent treatment-resistant hypertension did not have true TRH.
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