Different faces of resistant hypertension in obesity

Abstract

Background: The aim was to conduct a comparative assessment between pseudo-resistant (due to different causes) and true resistant hypertension (RH) in obesity. Material and methods: The study included 302 patients with uncontrolled hypertension and obesity. Initial treatment efficacy was assessed 3 months after dual therapy was administered. Those patients who did not reach target blood pressure (BP) with dual therapy were switched to triple therapy. Among patients who received triple therapy, 69 people did not reach target BP (they received the fourth drug, spironolactone). All patients were additionally examined 6 months after the initiation of antihypertensive therapy. Results: Despite the achievement of target BP after 6 months of therapy, patients with resistant hypertension had significantly higher BP and more pronounced disturbances of the circadian rhythm compared with non-resistant patients. After 6 months of therapy, patients with true resistance had significantly higher SBP compared with pseudo-resistant patients. The normal circadian rhythm in patients with true resistance was significantly less common than in patients with pseudo-resistance. Compared with pseudo-resistance, the presence of true resistance in obesity was associated with higher SBP and aldosterone levels, as well as lower body mass index (BMI) and low-density lipoprotein cholesterol (LDL-C). Conclusions: Even when target BP levels in antihypertensive therapy are achieved, obese resistant patients are characterized by more pronounced disturbances of the circadian rhythm and higher levels of office and out-of-office BP, compared with non-resistant patients. New data were obtained in the difference in the systolic blood pressure (SBP) levels (significantly higher with true resistance) and LDL-C (significantly lower with true resistance).