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Refractory Hypertension Is not Attributable to Intravascular Fluid Retention as Determined by Intracardiac Volumes.

Authors :
Velasco, Alejandro
Siddiqui, Mohammed
Kreps, Eric
Kolakalapudi, Pavani
Dudenbostel, Tanja
Arora, Garima
Judd, Eric K.
Prabhu, Sumanth D.
Lloyd, Steven G.
Oparil, Suzanne
Calhoun, David A.
Source :
Hypertension (0194911X); Aug2018, Vol. 72 Issue 2, p343-349, 7p
Publication Year :
2018

Abstract

Refractory hypertension (RfHTN) is an extreme phenotype of antihypertensive treatment failure defined as lack of blood pressure control with ≥5 medications, including a long-acting thiazide and a mineralocorticoid receptor antagonist. RfHTN is a subgroup of resistant hypertension (RHTN), which is defined as blood pressure >135/85 mm Hg with ≥3 antihypertensive medications, including a diuretic. RHTN is generally attributed to persistent intravascular fluid retention. It is unknown whether alternative mechanisms are operative in RfHTN. Our objective was to determine whether RfHTN is characterized by persistent fluid retention, indexed by greater intracardiac volumes determined by cardiac magnetic resonance when compared with controlled RHTN patients. Consecutive patients evaluated in our institution with RfHTN and controlled RHTN were prospectively enrolled. Exclusion criteria included advanced chronic kidney disease and masked or white coat hypertension. All enrolled patients underwent biochemical testing and cardiac magnetic resonance. The RfHTN group (n=24) was younger (mean age, 51.7±8.9 versus 60.6±11.5 years; P=0.003) and had a greater proportion of women (75.0% versus 43%; P=0.02) compared with the controlled RHTN group (n=30). RfHTN patients had a greater left ventricular mass index (88.3±35.0 versus 54.6±12.5 g/m2; P<0.001), posterior wall thickness (10.1±3.1 versus 7.7±1.5 mm; P=0.001), and septal wall thickness (14.5±3.8 versus 10.0±2.2 mm; P<0.001). There was no difference in B-type natriuretic peptide levels and left atrial or ventricular volumes. Diastolic dysfunction was noted in RfHTN. Our findings demonstrate greater left ventricular hypertrophy without chamber enlargement in RfHTN, suggesting that antihypertensive treatment failure is not attributable to intravascular volume retention. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
0194911X
Volume :
72
Issue :
2
Database :
Supplemental Index
Journal :
Hypertension (0194911X)
Publication Type :
Academic Journal
Accession number :
130618855
Full Text :
https://doi.org/10.1161/HYPERTENSIONAHA.118.10965