Predictors of blood pressure control in patients with resistant hypertension after intensive management in two expert centres: the Brussels-Torino experience

Figures & data

Table 1. Characteristics of patients with resistant hypertension at baseline.

Characteristics	Overall cohort (n = 313)
Age	61 (± 12)
Age at diagnosis of RHTN	56 (± 12)
Sex (men) [n (%)]	160 (51%)
BMI (kg/m^2)	31 (± 6.7)
Current smoker [n (%)]	72 (23%)
Ever smoker [n (%)]	149 (48%)
Dyslipidaemia [n (%)]	196 (63%)
Type 2 Diabetes [n (%)]	99 (32%)
CKD – EPI-CKD equation (eGFR <60 mL/min/1.73 m^2) [n (%)]	71 (23%)
Coronary Artery Disease
Acute Myocardial Infarction	51(16%)
CABG	19(6%)
PCI	42(13%)
Unstable Angina	4 (1%)
Heart Failure	14 (5%)
Valvular disease	17 (5%)
Arrhythmia
Atrial fibrillation	18(6%)
Other	7 (2%)
LVH [n (%)]	130 (42%)
OSAS	85(27%)
Requiring cPAP	51(17%)
Not requiring cPAP	31 (10%)
Stroke	21 (7%)
Transient Ischaemic Attack	7 (2%)
Peripheral Vascular Disease	29 (9%)
Serum creatinine (mg/dL)	1.1 (± 0.4)
Serum potassium (mmol/L)	4 (± 0.5)
eGFR (ml/min/1.73 m^2)	75 [56–88]
Haemoglobin (g/dL)	14.3 [13.2–15.3]
Albuminuria (g/24 h)	23.64 [6.89–115]
Proteinuria (g/24 h)	0.14 [0.1–0.7]
HbA1c	6.1 [5.6–6.8]
No. of antihypertensive drugs classes at baseline	5 [4–6]
No. of drugs	8 [5–11]

BMI: Body Mass Index; CKD: Chronic Kidney Disease; CABG: Coronary Artery Bypass Graft; PCI: Percutaneous Coronary Intervention; LVH: Left Ventricular Hypertrophy; OSAS: Obstructive Sleep Apnea Syndrome; HTN: Hypertension; eGFR: estimated Glomerular Filtration Rate.

Figure 1. Changes in antihypertensive drugs prescription from baseline to follow-up in the overall cohort of resistant hypertensive patients. *p-Value <0.001. RAS: Renin-Angiotensin-System; FU: Follow-up; CCBs: Calcium Channel Blockers; TZD: Thiazide diuretics.

Figure 2. Office and ambulatory BP changes between baseline and follow-up in persistent resistant and controlled hypertensive at follow-up. SBP: Systolic Blood Pressure; DBP: Diastolic Blood Pressure.

Table 2. Predictors of eventual blood pressure control at last follow-up in the expert centre.

	Univariate analysis		Multivariate analysis
Variable	Odds ratio (95% IC)	p Value	Odds ratio (95% IC)	p Value
Baseline Office SBP*	0.98 [0.97–0.99]	0.009	0.98 [0.95–1.02]	0.4
Baseline Office PP*	0.98 [0.97–0.99]	0.004
N. of antihypertensive drugs at baseline	0.74 [0.62–0.88]	0.001	0.62 [0.36–1.10]	0.1
History of Myocardial Infarction	0.27 [0.10–0.73]	0.009
Cognitive reappraisal score	1.95 [1.11–3.40]	0.019	2.06 [1.10–3.84]	0.02

SBP: Systolic Blood Pressure; PP: Pulse Pressure.

*OR/mmHg

Figure 3. Hypothetical model of the interactions between drug adherence, psychological profile and target organ damage in the pathogenesis of resistant hypertension.

Target organ damage, poor drug adherence and previous traumatic experiences/altered psychological profiles are the cornerstones of resistant hypertension, the “white elephant” in the field. They may be involved either separately or jointly. A few possible scenarios include: (i) poor drug adherence (2) may lead to TOD (1), which increases drug resistance even when drug adherence is afterwards improved; (ii) in hypertensive patients with increased arterial stiffness and/or TOD (1), reaching BP control may be difficult, inducing them to stop medications because of discouragement (2); (iii) altered psychological profiles (3) may be responsible for intentional (i.e. Münchausen syndrome) poor adherence (2), leading to an increased risk of TOD and finally of RHTN (1); (iv) or induce neuro-hormonal or inflammatory changes eventually leading to RHTN (1), irrespective of drug adherence.