What is the clinical evidence from this study?

Study design: Observational. Population: Refractory hypertension (n=36). Intervention: Refractory hypertension (non-RAS) vs. Reference group. Primary outcome: Low occupational status (manual or unskilled non-manual workers) (p=<0.01).

May 1, 1991

Characteristics of patients resistant to antihypertensive drug therapy

Q: What are the key findings of this study?

Refractory hypertension without renal artery stenosis was associated with lower occupational status (76% vs 42%; P<0.01), higher BMI, and more mental distress (44% vs 12%; P<0.001).

Key Result

Refractory hypertension without renal artery stenosis was associated with lower occupational status (76% vs 42%; P<0.01), higher BMI, and more mental distress (44% vs 12%; P<0.001).

Study Design

Type

Observational (n=36)

Multicenter

Structured PICO

What are the clinical and psychosocial characteristics of patients with refractory hypertension compared to a reference group?

Population

36 patients aged <65 years with refractory hypertension on triple drug therapy evaluated to determine characterizing psychosocial and clinical features.

Comparator

Reference group of non-refractory hypertensive patients

Outcome

Clinical and psychosocial characteristics associated with refractory hypertension

Refractory hypertension is strongly associated with secondary causes like renal artery stenosis, as well as significant psychosocial distress, obesity, and diabetes, highlighting the need for comprehensive screening and management.

Main Result

Absolute Event Rate: 76% vs 42%

p-value: p=<0.01

Abstract

In order to determine the features that characterize refractory hypertension (RH), patients aged less than 65 years in a hypertension clinic were screened. Thirty-six patients on triple drug therapy with a supine diastolic blood pressure (DBP) of greater than or equal to 5 mmHg above an identified target pressure (90-100 mmHg), or a systolic blood pressure (SBP) greater than or equal to 170 mmHg for the last 6 months (greater than or equal to 3 measurements) underwent a thorough clinical investigation. The frequency of renal artery stenosis (RAS) in the RH patients was 30%. The non-RAS patients had a low occupational status, 76% being either manual workers or unskilled non-manual workers (reference group: 42%; P less than 0.01). They were more obese (body mass index (BMI) 28.8 vs. 25.8; P less than 0.01), and had a longer duration of hypertensive disease. RH patients had a higher prevalence of non-insulin-dependent diabetes mellitus (18 vs. 6%; P less than 0.05), and showed a higher prevalence of nervous complaints and mental distress (44% vs. 12%; P less than 0.001) and musculo-skeletal pain (39% vs. 7%: P less than 0.001). It is suggested that refractory hypertension should be investigated and treated bearing psychosocial factors in mind, concurrently with a screening for secondary hypertension.

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