RELATIONSHIP OF RESISTANT HYPERTENSION TO CARDIOMETABOLIC RISK FACTORS AND THERAPY IN OUT-WARD PATIENTS IN REAL-LIFE MEDICINE

Introduction. Resistant hypertension (RH) is defined as an uncontrolled arterial hypertension (AH) treated with 3+ drrugs including diuretics (ECS/EHS 2007) or treated with 3+ drugs irrespectively of diuretics (AHA 2008). Relationship of RH to cardiometabolic risk factors or antihypertensive therapy is seldomly analysed in out-ward pts.
Methods. Cross-sectional multicentric study NEMESYS screened 10300 consecutive out-ward adult  pts. AH was found in 6583 pts, of whom 1085 were untreated. AH was controlled in 40,6% pts. Combination of 3+ drugs  (diuretics+) (ECS/EHS 2007) was found in 1643 pts (29.9%), RH was present in 492 pts (8.9% of treated). RH (AHA 2008)  was present in a additional 245 AH pts (4.5%).  
Results. RH both according to ESC/ESH 2007 and AHA 2008 definitions was determined by the same cardiometabolic risk factors in similar proportions: Overweight [BMI≥25]: OR= 1.73 vs 1.64; obesity  [BMI≥30]: OR= 1.75 vs. 1,62; abdominal obesity[IDF 2005]: OR= 1.76 vs. 1.60; metabolic syndrom [IDF 2005]: OR= 1.54  vs. 1.46; DM2: OR= 1.63 vs 1.54. Patients did no differ in age, BP or absolute risk. Comparing effect of therapy on probability of  RH, we found favourable trend only for beta blockers (OR: 0.83 (0.67-1.03), p=.103) but neutral or increased OR for other therapy – ACEI- 0.99 (0.78-1.25), p=.953; ARB- 1.21 (0.94-1.56), p=.158; CCB- 1.33 (1.06-1.66), p=.014;  aBl- 1.52 (0.96-2.40), p= .080. In AHA 2008 definition showed diuretics trend to protective effect against RH: 0.79 (0.62-1.02), p=.072.
 Conclusion. Prevalence of resistant hypertension in out-ward pts reached 8.9% res. 13.4% according to the definition. Our results support the definition of AHA 2008  as more suitable for clinical practice due to identification of more patients at high cardiovascular risk. Only betablockers and diuretics exhibited favourable trend against RH.