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Objective: To determine causes of treatment resistance in patients with refractory hypertension, and to estimate the prevalence of true resistant hypertension. Methods: We studied 50 consecutive patients referred with refractory hypertension after exclusion of hypokalemia and stenosis of the renal artery. Ambulatory blood pressure monitoring was performed in all patients to detect white-coat effect. The patients were hospitalized, antihypertensive drugs were withdrawn and a screening for secondary hypertension was performed. In addition, these patients, and a control group of essential hypertensives controlled with three antihypertensive drugs, underwent a OGTT with 75 g of glucose. Results: Primary normokaliemic hyperaldosteronism was diagnosed in seven patients. Two patients had a pheochromocytoma and six had white-coat effect. The 35 remaining patients with true resistant hypertension shown significant differences in serum insulin and HOMA IR when compared with the control group. Conclusions: These findings show that among normokaliemic treatment-resistant hypertension, the presence of hyperaldosteronism and pheochromocitoma is quite high. Moreover, treatment resistance in hypertensive patients appears to be associated with insulin resistance. [ABSTRACT FROM AUTHOR]

In daily practice, arterial hypertension (AHT) and hypercholesterolaemia are frequently associated with the existence of multiple common etiopathogenic interrelationships. This situation leads to an exponential increase in cardiovascular risk for these patients, so it is essential to know the prevalence and therapeutic management of hypercholesterolaemia in the hypertensive patient. This national study analyses the distribution of total cholesterol levels and low-density lipoprotein cholesterol as well as hypercholesterolaemia prevalence and its therapeutic management in the uncontrolled hypertensive Spanish population. We observed mean total cholesterol levels of 227 ± 41 mg/dl with a high prevalence of hypercholesterolaemia (34.2%) among hypertensive patients, and the percentage of those patients with “desirable” total cholesterol levels (<200 mg/dl) was <25%. The treated hypertensive patients presented both significantly higher mean cholesterol levels and greater hypercholesterolaemia prevalence than the untreated hypertensive patients. It appears that total cholesterol levels are scarcely related to the presence or non-presence of obesity, diabetes or smoking. Regarding treatment, only 14.6% of the hypercholesterolaemic hypertensive patients received hypolipaemic treatment with statins. These results support the need to introduce measures for better diagnostic and therapeutic management of hypercholesterolaemic hypertensive patients that will lead to a much higher reduction in cardiovascular risk for these patients. [ABSTRACT FROM AUTHOR]