Abstract
Introduction: Resistant hypertension (RH), a leading risk factor for cardiovascular disease is defined as the failure to achieve targeted blood pressure (BP) in patients, despite optimal administration of 3 standard antihypertensive agents, one of which is a diuretic.1,2
Methods: Records of hypertensive patients attending the Cardiovascular Risk (CVR) clinic at NHS Tayside, were audited over a 1-month period, and 24-h home BP readings recorded, to verify the conformity to hypertension management guidelines of National Institute for Health and Care Excellence (NICE)3 and British and Irish Hypertension Society (BIHS).4
Results: Of the 61 patient records audited, 25 patients (41%) were identified with RH while 36 patients (59%) were non-RH. The mean ASSIGN scores for RH patients were 25 compared to 14.4 in non-RH patients.
Only 20% of RH patients were administered the 3 recommended drug classes on referral, recording average BP of 150/85 mm Hg. Also, 20% of RH patients reported at least 1 drug intolerance.
80% of the hypertensive patients referred to the clinic required ≥4 agents but only 50% of the patients on ≥4 drugs achieved good BP controls with average BP reading of 120/70 mm Hg.
In this sample, older patients were more likely to achieve target BP levels with average BP of 130/70 mm Hg compared to younger patients under 60 years whose average BP was 150/80 mm Hg.
Conclusions: While guidelines of NICE and BIHS were adhered, audit results indicate multiple drug intolerances, comorbidities and probable patient non-compliance, as having contributory effects on RH.
Multidrug regimen places RH patients at elevated risk of adverse effects like hypotension and syncope.5 Studies aimed at assessing efficacy of such regimens is required to help guide therapy. Furthermore, future research aimed at evaluating RH aetiology may help in identifying drug resistance causes and strategizing treatment.
Methods: Records of hypertensive patients attending the Cardiovascular Risk (CVR) clinic at NHS Tayside, were audited over a 1-month period, and 24-h home BP readings recorded, to verify the conformity to hypertension management guidelines of National Institute for Health and Care Excellence (NICE)3 and British and Irish Hypertension Society (BIHS).4
Results: Of the 61 patient records audited, 25 patients (41%) were identified with RH while 36 patients (59%) were non-RH. The mean ASSIGN scores for RH patients were 25 compared to 14.4 in non-RH patients.
Only 20% of RH patients were administered the 3 recommended drug classes on referral, recording average BP of 150/85 mm Hg. Also, 20% of RH patients reported at least 1 drug intolerance.
80% of the hypertensive patients referred to the clinic required ≥4 agents but only 50% of the patients on ≥4 drugs achieved good BP controls with average BP reading of 120/70 mm Hg.
In this sample, older patients were more likely to achieve target BP levels with average BP of 130/70 mm Hg compared to younger patients under 60 years whose average BP was 150/80 mm Hg.
Conclusions: While guidelines of NICE and BIHS were adhered, audit results indicate multiple drug intolerances, comorbidities and probable patient non-compliance, as having contributory effects on RH.
Multidrug regimen places RH patients at elevated risk of adverse effects like hypotension and syncope.5 Studies aimed at assessing efficacy of such regimens is required to help guide therapy. Furthermore, future research aimed at evaluating RH aetiology may help in identifying drug resistance causes and strategizing treatment.
| Original language | English |
|---|---|
| Article number | P-49 |
| Pages (from-to) | 32 |
| Number of pages | 36 |
| Journal | Journal of Human Hypertension |
| Volume | 37 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 7 May 2024 |
| Event | British and Irish Hypertension Society Annual Scientific Meeting - Aberdeen Duration: 18 Sept 2023 → 20 Sept 2023 |
Keywords
- Resistant Hypertension
- Blood Pressure
- Anti-hypertensive agents
