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I posicionamento brasileiro sobre hipertensão arterial resistente

2012; Sociedade Brasileira de Cardiologia (SBC); Volume: 99; Issue: 1 Linguagem: Inglês

10.1590/s0066-782x2012000700002

1678-4170

Alexandre Alessi, Andréa Araújo Brandão, António Coca, A. C. C. Cordeiro, A. C. C. Cordeiro, Armando da Rocha Nogueira, Feitosa Diógenes de Magalhães, Audes D. M. Feitosa, Celso Amodeo, Cibele Isaac Saad Rodrigues, Cibele Isaac Saad Rodrigues, David A. Calhoun, David A. Calhoun, Eduardo Barbosa Coelho, Eduardo Costa Duarte Barbosa, Eduardo Pimenta, Elizabeth Silaid Muxfeldt, Fernanda Marciano Consolim‐Colombo, Fernanda Marciano Consolim‐Colombo, Gil F. Salles, Guido Bernardo Aranha Rosito, Heitor Moreno, José Fernando Vilela-Martin, J. C. Yugar, Luiz Aparecido Bortolotto, Luiz Aparecido Bortolotto, Luiz César Nazário Scala, Luís Cesar N. Scala, Márcio Gonçalves de Sousa, Márcio de Souza, Marco Antônio Mota Gomes, Marcus Bolivar Malachias, Miguel Gus, Oswaldo Passarelli, Paulo César Brandão Veiga Jardim, Paulo Roberto Pereira Toscano, Ramiro Sánchez, Ramiro Sanchez, Roberto Dischinger Miranda, Roberto Dischinger Miranda, Rui Póvoa, Weimar Kunz Sebba Barroso,

Hormonal Regulation and Hypertension

Resistant Hypertension (RH) is defined as blood pressure (BP) that remains above the recommended target in spite of the use of three antihypertensive drugs with synergistic actions at maximum recommended and tolerated doses, one of which should preferably be a diuretic, or when four or more different antihypertensive drugs are used, even when BP is controlled 1 .True RH must be differentiated from pseudo-resistance, which occurs due to non-adherence to treatment, inadequate blood pressure measurements, use of inadequate doses or therapeutic regimens, or the occurrence of white-coat effect 2 . Control of hypertension in Brazil and worldwideAn average of 30% of the adult population has high blood pressure (HBP), about 1.2 billion people in the world 3 .In Brazil, 14 population-based studies (1994-2009) revealed low levels of BP control (19.6%) 4 .The fact that hypertension control doubled in the U. S. from 1988 to 2008 (27.3% vs. 53.5%) 5 , and increased fivefold in Canada from 1992 to 2009 (13.2% vs. 64.6%) 6, reflects important advances in HBP detection and treatment in these countries. Incidence and prevalence of resistant hypertensionDaugherty et al. found an RH incidence of 1.9% in an 18-month follow-up of hypertensive patients who started treatment.This study involved a large cohort of ethnically diverse patients and took treatment adherence into account, therefore excluding pseudo-resistance 7 .Although the exact RH prevalence has not been established yet, it is estimated that the condition affects 12-15% of individuals with high blood pressure 8 .Data from the National Health and Nutrition Examination Survey (NHANES) in the period of 2003 to 2008 showed that 12.8% of hypertensive patients taking antihypertensive drugs in the United States had RH 9 .Egan et al. 10 noted that these percentages have increased in the United States. Factors contributing to resistant hypertensionBoth systolic and diastolic hypertension may be resistant, the former being more prevalent 1 .Causal factors include increased sensitivity to salt, fluid overload (due to increased sodium intake, chronic nephropathy, or inadequate diuretic therapy), exogenous substances (non-hormonal antiinflammatory drugs, corticosteroids, oral contraceptives, sympathomimetics, chemotherapy drugs, antidepressants, immunosuppressants, decongestants, anorectics, alcohol, and cocaine), and secondary causes of hypertension (emphasizing primary aldosteronism, obstructive sleep apnea, chronic nephropathy, and renal artery stenosis) 11,12 .The following characteristics are predominant in patients with resistant hypertension: older age, African descent, obesity, left ventricular hypertrophy, diabetes mellitus, chronic kidney disease, metabolic syndrome, increased salt intake, and reduced physical activity.It should be noted that the whitecoat effect is present in about 30% of RH patients 1,13 .