Which factors are linked to treatment-resistant hypertension?

A recent study has shown that individuals with treatment-resistant hypertension (TRH) tend to be older, have diabetes, and higher urine albumin, among others.

The investigators performed a comprehensive evaluation of 141 adult patients with treated hypertension without confirmed secondary causes from the West Midlands Hypertension Centre, UK. The participants underwent tests for endothelial function, body composition, arterial stiffness, sleep study, and inflammation and endothelial biomarkers.

Of the patients, 60 (43 percent) had true TRH after excluding whitecoat effect, secondary hypertension, and medication nonadherence. Patients with TRH were significantly older, more frequently had diabetes, and a longer duration of hypertension, as well as higher rates of left ventricular hypertrophy, higher extracellular water, urine albumin, and lower estimated glomerular filtration rate.

Higher cardiac biomarkers (serum NT-proBNP and hs-troponin), inflammatory markers (serum free light chains), aldosterone:renin ratio, and serum endothelin-1 were also observed in the true TRH group.

No between-group difference was noted in adjusted arterial stiffness, reactive hyperaemia, or overnight pulse oximetry. In multivariate analysis, only NT-proBNP remained significantly associated with TRH (p=0.027).

“[This] study provides valuable insights into the possible pathophysiological mechanisms of TRH,” the investigators said. “These results emphasize the need for further research into the mechanisms underlying TRH and potential management strategies.”

TRH refers to uncontrolled blood pressure despite using at least three antihypertensive medications at maximum tolerated doses. It may increase the risks of cardiovascular events, kidney disease, and mortality, according to the investigators.