Clinical Characteristics of Resistant vs. Refractory Hypertension in a Population of Hypertensive Afrodescendants

Abstract Background Afrodescendants have been associated with a greater severity of arterial hypertension and a higher incidence of cardiovascular complications. Characteristics in the presentation of resistant hypertension (RH) or refractory hypertension (RfH), specifically in this ethnic group, have not been properly studied. Objectives The study compares clinical and epidemiological characteristics and prevalence of cardiovascular events in people of African descent diagnosed with RH or RfH. Methods Cross-sectional study carried out in a referral clinic for patients with severe hypertension. The level of significance was 5%. Results 146 consecutive patients were evaluated, of which 68.7% were female. The average age was 61.8 years, with 88.4% of Afrodescendants (mixed race or black). 51% had RfH. There was a high prevalence of cardiovascular risk factors: 34.2% of subjects had diabetes, 69.4% dyslipidemia, 36.1% obesity, and 38.3% history of smoking. Reduced renal function was seen in 34.2%. Previous cardiovascular events occurred in 21.8% for myocardial infarction and in 19.9% for stroke. The Framingham’s risk score was moderate/high at 61%. RfH patients were younger (mean age 59.38±11.69 years versus 64.10±12.23 years, p=0.02), had more dyslipidemia (83.8 versus 66.7%, p=0.021), and stroke (30.4 versus 12.3%, p=0.011) when compared to those with RH. The use of a combination of ACEi/ARB+CCB+Diuretic, chlortalidone and spironolactone was also more frequent in individuals with RfH. Conclusion Africandescendant people with RH had a high cardiovascular risk, a high prevalence of RfH, a higher frequency of dyslipidemia and stroke, compatible with a high incidence of injury to target organs. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

背景：非洲裔后裔群体与动脉高血压病情更严重、心血管并发症发生率更高密切相关。但针对该特定族群的抵抗性高血压（resistant hypertension, RH）或顽固性高血压（refractory hypertension, RfH）的临床表型特征，尚未得到充分研究。目的：本研究对比分析确诊为抵抗性高血压（RH）或顽固性高血压（RfH）的非洲裔后裔的临床、流行病学特征及心血管事件患病率。方法：本研究为横断面研究，在一家重症高血压患者转诊诊所开展，检验水准设定为5%。结果：共纳入146例连续性就诊患者，其中68.7%为女性；平均年龄61.8岁，88.4%为非洲裔后裔（混血或黑人）。51%的患者被诊断为顽固性高血压（RfH）。心血管危险因素患病率较高：34.2%的受试者合并糖尿病，69.4%合并血脂异常，36.1%合并肥胖，38.3%有吸烟史；34.2%存在肾功能减退。既往心血管事件情况：心肌梗死发生率为21.8%，卒中发生率为19.9%。弗雷明汉风险评分（Framingham’s risk score）呈中/高危水平的患者占比为61%。与RH患者相比，RfH患者年龄更小（平均年龄59.38±11.69岁 vs 64.10±12.23岁，p=0.02），血脂异常（83.8% vs 66.7%，p=0.021）及卒中病史（30.4% vs 12.3%，p=0.011）的占比更高；RfH患者更常采用血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂（ACEI/ARB）+钙通道阻滞剂（CCB）+利尿剂、氯噻酮及螺内酯联合治疗方案。结论：合并抵抗性高血压（RH）的非洲裔后裔群体心血管风险较高，顽固性高血压（RfH）患病率高，血脂异常及卒中病史的发生率更高，这与靶器官损伤高发的临床特征相符。（《Arq Bras Cardiol》2020; [在线预刊]，第0-0页）