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IS RESISTANT HYPERTENSION TRULY RESISTANT?
Author(s) -
Brown Mark A,
Buddle Megan L,
Martin. Allison
Publication year - 2000
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1046/j.1440-1797.2000.abs160.x
Subject(s) - medicine , white coat hypertension , resistant hypertension , masked hypertension , ambulatory blood pressure , cardiology , referral , cohort , ambulatory , blood pressure , pediatrics , family medicine
Objectives (1) to compare the magnitude of the white‐coat effect in patients with mild and resistant hypertension and (2) to determine the prevalence of controlled BP in patients with ‘resistant’ hypertension. Methods Referring doctors' BP was compared with awake and 24 hour ambulatory BP monitor (ABPM) BP in 922 hypertensive patients referred for ABPM by their general practitioners (42%) or specialists (58%). 432 were taking no antihypertensives at the time of their ABPM study (Group 0), 336 were taking 1‐2 antihypertensive drugs (Group 1) and 154 were taking ≥ 3 antihypertensive drugs (Group 2 ‐ resistant hypertension). Controlled BP was defined as awake ABPM BP < 135/85mmHg. Results Patients with resistant hypertension were significantly older (60 ± 13 yrs) than group 0 (44 ± 15 yrs) and group 1 (55 ± 14 yrs) patients (p < 0.001) but were of similar weight, height and upper arm circumference. The difference between referral BP and awake ABPM BP, the white‐coat effect (WCE), increased significantly across the groups (15/9 vs 26/14 vs 29/15 mmHg, p < 0.005). 34% of group 0 patients had normal ABPM BP, ie. white‐coat hypertension, while 34% of group 1 and 26% of group 2 patients had controlled BP by ABPM criteria. Conclusion Approximately 1 in 3 of this selected cohort exhibited white coat hypertension and 1 in 4 of those with apparent resistant hypertension had well controlled BP when assessed by 24 hour ABPM. ABPM appears an appropriate initial step in the investigation of both mild hypertension and apparent drug resistant hypertension, thereby reducing unnecessary drug treatment and investigations for secondary causes of hypertension in these patients.