Open AccessResistant Hypertension: Risk Factors, Subclinical Atherosclerosis, and Comorbidities Among Adults—The Brazilian Longitudinal Study of Adult Health ( ELSA ‐Brasil)
Author(s) -
Lotufo Paulo A.,
Pereira Alexandre C.,
Vasconcellos Paulo S.,
Santos Itamar S.,
Mill Jose Geraldo,
Bensenor Isabela M.
Publication year - 2015
Publication title -
the journal of clinical hypertension
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.909
H-Index - 67
eISSN - 1751-7176
pISSN - 1524-6175
DOI - 10.1111/jch.12433
Subject(s) - medicine , pulse wave velocity , blood pressure , subclinical infection , diabetes mellitus , renal function , cardiology , left ventricular hypertrophy , atrial fibrillation , antihypertensive drug , albuminuria , cohort , confidence interval , endocrinology
The frequency of resistant hypertension—defined as blood pressure (BP) ≥140/90 mm Hg with proven use of three antihypertensive medications, or as the use of four antihypertensive drug classes regardless of BP—is unknown in low‐middle–income countries. Using data from the Brazilian Longitudinal Study of Adult Health, a cohort of 15,105 civil servants aged 35 to 74 years, the authors identified 4116 patients taking treatment for hypertension, 11% of who had resistant hypertension. These participants were more likely to be older, black, less educated, poorer, and obese. The adjusted prevalence ratios (95% confidence intervals) were diabetes, 1.44 (1.20–1.72); glomerular filtration rate (<60 mL/min/1.72 m 2 ), 1.95 (1.60–2.38); albumin‐to‐creatinine ratio (>300 mg/g), 2.43 (1.70–3.50); carotid‐femoral pulse‐wave velocity, 1.07 m/s (1.03–1.11 m/s); common carotid intima‐media thickness, 2.57 mm (1.64–4.00 mm); left ventricular hypertrophy, 2.08 (1.21–3.57); and atrial fibrillation, 3.55 (2.02–6.25). Thus, the prevalence of resistant hypertension in Brazil is high and associated with subclinical markers of end‐organ cardiovascular damage.