PROGNOSIS IN THERAPY-RESISTANT HYPERTENSION

Objectives. To study the prognosis in therapy-resistant hypertension ( RH). Design. Patients with RH and age- and sex-matched responding hype rtensives, were followed-up for a period of 7 years. Setting. All subj ects were outpatients at a secondary referral centre for hypertension. Subjects. (i) Age less than or equal to 65 years; (ii) no prior diagn osis of secondary hypertension; (iii) on antihypertensive triple-drug therapy of optimal dosage; (iv) diastolic blood pressure remaining 5 m mHg above their (age-related) target pressure; (v) no history of renal failure, heart failure, stroke or myocardial infarction; and (vi) no record of noncompliance. A total of 800 patients were screened. Thirty -six were finally included. For each study patient, two control patien ts were randomly selected. Interventions. Continuous efforts to optimi ze blood pressure control were made in all patients. Main outcome meas ures. Transient ischaemic attack or stroke, myocardial infarction, con gestive heart failure, renal failure, and death. Development of nonins ulin-dependent diabetes mellitus (NIDDM). Results. At the end of the f ollow-up period, RH had a casual functional blood pressure 21/6 mmHg h igher than the control hypertensives. RH exhibited an increased incide nce of stroke (P < 0.05), renal insufficiency (P < 0.05) and NIDDM (P < 0.05). RH patients had an increased risk of suffering an event durin g the 7 years [odds ratio (OR) 2.71; P < 0.05]. Conclusions. Resistanc e to antihypertensive therapy may persist even when therapy is aggress ively applied in compliant patients. RH is associated to an increased risk of stroke and of target organ damage, foremost renal insufficienc y. The apparent association between RH, obesity and NIDDM may imply th at hyperinsulinaemia is involved in therapy resistance.