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Objective: High blood pressure is the most deadly risk factor for women worldwide. Resistant hypertension (RH) is defined as office and ambulatory blood pressure (BP) requiring 4 or more antihypertensive medications, whether controlled or uncontrolled. Women are at greater risk of developing resistant hypertension than men. Design and method: 1119 resistant hypertensive patients diagnosed by ambulatory BP monitoring as true RH patients were divided into two groups: controlled RH (CRH) group, n = 489 and uncontrolled RH (URH), n = 630. The body mass index (BMI) was calculated and all patients were evaluated for nonmodifiable risk faktors, which included age and sex, and modifiable risc factors and concomitant diseases, such as smoking, use of alcohol, Dyslipidemia, Obesity, Diabetes mellitus, Ischemic heart disease, Renal disease and Cerebrovascular disease. Laboratory evaluation included fasting glycemia, creatinine, uric acid, lipids, microalbuminuria. Conventional and TDI echocardiography were performed in all patients, included E/Em (ratio of diastolic velocities), left ventricular mass index (LVM) and left atrial volume index (LAVI) were calculated according to the recommendation (ASE/EACVI). Statistical analysis included bivariate logistic regression. Results: Patients with URH were older (72±9.8 vs 71±10.7;p=0,01), more obese (28.0±4.0 vs 27.6±3.3;p=0.036), they also had higher prevalence of Diabetes mellitus (241(38.3%) vs 141(28.8%);p=0,001) and significantly more often in menopause or postmenopause (402(63.8%) vs 287(58.7%); p=0.046). LAVI (43.7±17.7 vs 40.2±15.0;p=0,001), LVEDV (183.3±46.3 vs 177.3±48.7;p=0,038), LVESV (82.2±24.9 vs 78.2±24.8,;p=0,007)), LVMI (116.2±23.2 vs 111.2±22.9;p=0,0003), E/Em (15.0±3.7 vs 14.5±3.8;p=0.038) and uric acid (356.3±106.7 vs 340.1±103;.p=0,028) were significantly higher in this group. Uncontrolled RH associated with older age (0.987(0.975-0.999); p=0,032), obesity (0.968(0.936-1.000);p=0,049) and diabetes (1.467(1.132-1.901);p=0,004), but not with menopause. Having left ventricular hypertrophy (0.992(0.987-0,998);p=0,008), increased LAVI (0.991(0.984-0.999);p=0.023) and higher uric acid (1.001 (1.000-1.003), p =0.038) are also associated with URH. Conclusions: The prevalence of uncontrolled RH in women was high, despite optimal therapy. Hypetension remains uncontrolled in patients who are older, obese, with diabetes, left ventricular hypertrophy, and in menopause. Higher uric acid level also seems to have a negative influence on the control of the disease. High prevalence of poor blood pressure control motivates promotion of new therapeutic strategies and lifestyle changes.
Stevanovic et al. (Wed,) studied this question.