Background: This study aimed to determine the frequency of refractory hypertension (RH) and investigate the factors affecting RH in Turkish hypertensive patients. Materials and methods: Totally 400 hypertensive patients (114 males and 286 females) were enrolled. Blood pressure (BP) was measured by patients at home two times a day. The patients were called for controlling in every four weeks, and those who had BP <140/90 mmHg were not followed-up. In patients with BP >140/90 mmHg drug doses were increased or another antihypertensive drug was added and the patients were continued to be followed-up. The total follow-up period was 36 weeks. Patients with persisting BP >140/90 mmHg despite triple medication administration including a diuretic form at least for 3 months at adequate doses were considered to have RH. Results: A total of 63 patients (15.8%), including 14 males and 49 females, were considered to have RH. Body Mass Index (BMI) values of patients with and without RH were 32.16±3.56 and 29.71±3.42, respectively (t=2.92; p=0.005). The rate of obese and morbidly obese patients was higher in the RH group (p<0.005). Duration of hypertension was longer in the RH group (9.7±5.6 vs 7.0±5.7 years, p<0.001). Conclusion: We found the frequency of RH as 15.8%. There’s a significant correlation between BMI and RH. Duration of hypertension increases the prevalence of RH, and should be considered one of the risks for RH.
Published in | American Journal of Internal Medicine (Volume 9, Issue 1) |
DOI | 10.11648/j.ajim.20210901.14 |
Page(s) | 21-25 |
Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
Copyright |
Copyright © The Author(s), 2021. Published by Science Publishing Group |
Hypertension, Antihypertensive Agents, Blood Pressure
[1] | Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK et al. Global burden of hypertension: analysis of worldwide data. Lancet 2005; 365 (9455): 217-223. doi: 10.1016/S0140-6736(05)17741-1. |
[2] | Ong KI, Cheung BM, Man YB, Lau CP, and Lam KSL. Prevalance, awareness, treatment, and control of hipertension among United States adults 1999-2004. Hypertension 2007 Jan; 49 (1): 69-75. doi: 10.1161/01.HYP.0000252676.46043.18. |
[3] | Wang YR, Alexander GC, Stafford RS. Outpatient hypertension treatment, treatment intensification, and control in Western Europe and the United States. Arch Intern Med. 2007 Jan 22; 167 (2): 141-7. doi: 10.1001/archinte.167.2.141. |
[4] | Marma AK, Lloyd-Jones DM. Systematic examination of the updated Framingham heart study general cardiovascular risk profile. Circulation 2009; 120 (5): 384-390. doi: 10.1161/circulationaha.108.835470. |
[5] | Shattuck Lecture. The hypertension paradox—more uncontrolled disease despite improved therapy. N Engl J Med 2009; 361 (9): 878-887. doi: 10.1056/NEJMsa0903829. |
[6] | Lloyd-Jones DM, Evans JC, Levy D. Hypertension in adults across the age spectrum: current outcomes and control in the community. JAMA 2005; 294 (4): 466–472. doi: 10.1001/jama.294.4.466. |
[7] | Lewington S, Clarke R, Qizilbash N, Peto R, Collins R et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360 (9349): 1903–1913. doi: 10.1016/S0140-6736(02)11911-8. |
[8] | Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A et al. 2013 ESH/ESC guidelines fort the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013; 34 (28): 2159-2219. doi: 10.1093/eurheartj/eht151. |
[9] | James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C et al. 2014 evidence-based guideline fort he management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014 Feb 5; 311 (5): 507-20. doi: 10.1001/jama.2013.284427. |
[10] | American Diabetes Association. Standards of medical care in diabetes-2013. Diabetes care 2013 Jan; 36 (suppl 1): S11-S66. doi.org/10.2337/dc13-S011. |
[11] | Kidney Disease; Improving Global Outcomes (KDIGO) Blood Pressure Work Group. KDIGO clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int Suppl. 2012; 2 (5): 337-414. |
[12] | Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988–2000. JAMA. 2003 Jul 9; 290 (2): 199–206. doi: 10.1001/jama.290.2.199. |
[13] | Lloyd-Jones DM, Evans JC, Larson MG, O’Donnell CJ, Rocella EJ et al. Differential control of systolic and diastolic blood pressure: factors associated with lack of blood pressure control in the community. Hypertension. 2000; 36 (4): 594-9. doi: 10.1161/01.hyp.36.4.594. |
[14] | Peralta CA, Hicks LS, Chertow GM, Ayanian JZ, Vittinghoff E et al. Control of hypertension in adults with chronic kidney disease in the United States. Hypertension. 2005 Jun; 45 (6): 1119-24. doi: 10.1161/01.HYP.0000164577.81087.70. |
[15] | The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Outcomes in high risk hypertensive patients randomized toangiotensin-convertingenzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to prevent Heart Attack Trial (ALLHAT). JAMA. 2002 Dec 18; 288 (23): 2981-97. doi: 10.1001/jama.288.23.2981. |
[16] | Julius S, Kjeldsen SE, Weber M, Brunner HR, Ekman S et al. Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial. Lancet. 2004 Jun 19; 363 (9426): 2022-31. doi: 10.1016/S0140-6736(04)16451-9. |
[17] | Dahlöf B, Sever PS, Poulter NR, Wedel H, Beevers DG, Caulfield M, et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet. 2005 Sep 10; 366 (9489): 895–906. doi: 10.1016/S0140-6736(05)67185-1. |
[18] | Black HR, Elliott WJ, Grandits G, Grambsch P, Lucente T et al. Principal results of the Controlled Onset Verapamil Investigation of Cardiovascular End Points (CONVINCE) trial. JAMA. 2003 Apr 23-30; 289 (16): 2073-2082. doi: 10.1001/jama.289.16.2073. |
[19] | Swales JD, Bing RF, Heagerty A, Pohl JE, Russell GI et al. Treatment of refractory hypertension. Lancet 1982: 319 (8277): 894-896. doi.org/10.1016/S0140-6736(82)92162-6 |
[20] | Frohlich ED. Classification of resistan hypertension. Hypertension. 1988 Mar; 11 (3 Pt 2): 1167-70. doi: 10.1161/01.hyp.11.3_pt_2.ii67. |
[21] | 1988 Joint National Committee. The 1988 report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressre. Arch Intern Med 1988; 148 (5): 1023-1038. |
[22] | Alderman MH, Budner N, Cohen H, Lamport B, Ooi WL. Prevalance of drug resistant hypertension. Hypertension 1988; 11: (Suppl II): 1171-1175. |
[23] | Staessen JA, Fagard R, Thijs L, Celis H, Arabidze GG, Birkenhager WH, et al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet 1999; 350: 757-764. |
[24] | Kjedsen SE, Dahlöf B, Devereux R, Julius S, Beevers G, Faire U, et al. For the LIFE study group. One year of antihypertensive treatment in patients with LVH: the LIFE study. Am J Hypertens 1999; 12: 142. |
[25] | Huang Z, Willett WC, Manson JE, Rosner B, Stampfer MJ, Speizer FE, et al. Body weight, weight change, and risk of hypertension in women. Ann Intern Med 1998; 128: 81-88. |
[26] | Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, et al. Prevalance of obesity, diabetes and obesity-related health risk factors, 2001. JAMA 2003; 289: 76-79. |
[27] | Thompson D, Edelsberg J, Colditz GA, Bird AP, Oster G. Lifetime health and economic consequence of obesity. Arch Intern Med 1999; 159: 2177-2183. |
[28] | Chapman N, Dobson J, Wilson S, Dahlöf B, Sever PS, Wedel H, et al. Effect of spironolactone on blood pressure in subjects with resistant hypertension. Hypertension 2002; 39: 982-988. |
[29] | Nishizaka MK, Zaman MA, Calhoun DA. Efficacy of low-dose spironolactone in subjects with resistant hipertansion. Am J Hypetens 2003; 16: 925-930. |
[30] | Primenta E, Calhoun DA. Treatment of resistant hypertansion. J Hypertens 2010; 28: 219-2195. |
APA Style
Mustafa Temizel, Ugur Dilek Calap, Murtaza Cit, Mansur Azermir, Yucel Arman. (2021). Frequency of Refractory Hypertension in Turkish Patients and Evaluation of the Factors Affecting Refractory Hypertension. American Journal of Internal Medicine, 9(1), 21-25. https://doi.org/10.11648/j.ajim.20210901.14
ACS Style
Mustafa Temizel; Ugur Dilek Calap; Murtaza Cit; Mansur Azermir; Yucel Arman. Frequency of Refractory Hypertension in Turkish Patients and Evaluation of the Factors Affecting Refractory Hypertension. Am. J. Intern. Med. 2021, 9(1), 21-25. doi: 10.11648/j.ajim.20210901.14
AMA Style
Mustafa Temizel, Ugur Dilek Calap, Murtaza Cit, Mansur Azermir, Yucel Arman. Frequency of Refractory Hypertension in Turkish Patients and Evaluation of the Factors Affecting Refractory Hypertension. Am J Intern Med. 2021;9(1):21-25. doi: 10.11648/j.ajim.20210901.14
@article{10.11648/j.ajim.20210901.14, author = {Mustafa Temizel and Ugur Dilek Calap and Murtaza Cit and Mansur Azermir and Yucel Arman}, title = {Frequency of Refractory Hypertension in Turkish Patients and Evaluation of the Factors Affecting Refractory Hypertension}, journal = {American Journal of Internal Medicine}, volume = {9}, number = {1}, pages = {21-25}, doi = {10.11648/j.ajim.20210901.14}, url = {https://doi.org/10.11648/j.ajim.20210901.14}, eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20210901.14}, abstract = {Background: This study aimed to determine the frequency of refractory hypertension (RH) and investigate the factors affecting RH in Turkish hypertensive patients. Materials and methods: Totally 400 hypertensive patients (114 males and 286 females) were enrolled. Blood pressure (BP) was measured by patients at home two times a day. The patients were called for controlling in every four weeks, and those who had BP 140/90 mmHg drug doses were increased or another antihypertensive drug was added and the patients were continued to be followed-up. The total follow-up period was 36 weeks. Patients with persisting BP >140/90 mmHg despite triple medication administration including a diuretic form at least for 3 months at adequate doses were considered to have RH. Results: A total of 63 patients (15.8%), including 14 males and 49 females, were considered to have RH. Body Mass Index (BMI) values of patients with and without RH were 32.16±3.56 and 29.71±3.42, respectively (t=2.92; p=0.005). The rate of obese and morbidly obese patients was higher in the RH group (pConclusion: We found the frequency of RH as 15.8%. There’s a significant correlation between BMI and RH. Duration of hypertension increases the prevalence of RH, and should be considered one of the risks for RH.}, year = {2021} }
TY - JOUR T1 - Frequency of Refractory Hypertension in Turkish Patients and Evaluation of the Factors Affecting Refractory Hypertension AU - Mustafa Temizel AU - Ugur Dilek Calap AU - Murtaza Cit AU - Mansur Azermir AU - Yucel Arman Y1 - 2021/01/22 PY - 2021 N1 - https://doi.org/10.11648/j.ajim.20210901.14 DO - 10.11648/j.ajim.20210901.14 T2 - American Journal of Internal Medicine JF - American Journal of Internal Medicine JO - American Journal of Internal Medicine SP - 21 EP - 25 PB - Science Publishing Group SN - 2330-4324 UR - https://doi.org/10.11648/j.ajim.20210901.14 AB - Background: This study aimed to determine the frequency of refractory hypertension (RH) and investigate the factors affecting RH in Turkish hypertensive patients. Materials and methods: Totally 400 hypertensive patients (114 males and 286 females) were enrolled. Blood pressure (BP) was measured by patients at home two times a day. The patients were called for controlling in every four weeks, and those who had BP 140/90 mmHg drug doses were increased or another antihypertensive drug was added and the patients were continued to be followed-up. The total follow-up period was 36 weeks. Patients with persisting BP >140/90 mmHg despite triple medication administration including a diuretic form at least for 3 months at adequate doses were considered to have RH. Results: A total of 63 patients (15.8%), including 14 males and 49 females, were considered to have RH. Body Mass Index (BMI) values of patients with and without RH were 32.16±3.56 and 29.71±3.42, respectively (t=2.92; p=0.005). The rate of obese and morbidly obese patients was higher in the RH group (pConclusion: We found the frequency of RH as 15.8%. There’s a significant correlation between BMI and RH. Duration of hypertension increases the prevalence of RH, and should be considered one of the risks for RH. VL - 9 IS - 1 ER -