Endocrine Abstracts

Resistant hypertension (RH) is defined as blood pressure above a goal despite adherence to at least three optimally dosed antihypertensive medications of different classes, one of which is a diuretic.

Objectives: We investigated the prevalence of true resistant hypertension in our Department of Endocrinology, and we described the clinico-biological features of theses patients.

Methods: We performed a retrospective descriptive study. True resistant hypertension was diagnosed when white coat phenomenon, lack of compliance and secondary hypertension were excluded in patients with blood pressure ≥140/90 mmHg in two consecutive visits, despite to be using three blood pressure-lowering agents, including a diuretic.

Results: The sample included 30 patients (20 womens and 10 mens) among 563 patients followed in our department for hypertension.

The mean age of our patients was 54 years. Fifty percent were aged more than 65 years. Dyslipidemia was noted in 50% cases, and diabetes mellitus in 60% cases. Etiological investigation included an exploration of the aldo renin axis maded in 4, Hyperadrenocorticism in 9 cases, urinary metanephrines in 6 cases, thyroid tests in 17 cases, renal ultrasound in 9 cases, a Doppler ultrasound of the renal arteries in 8 cases. This assessment concluded that a primary aldosteronism was founded in 3 cases, an hyperthyroidism was in 1 case and hyperadrenocorticism in one case. Complications associated with this (RH) were hypertensive retinopathy in 8 cases (26.6%), nephropathy in 6 cases (20%) and left ventricular hypertrophy in 7 cases (23.3%). Diuretic therapy was prescribed in 100% of cases, angiotensin-converting-enzyme inhibitor in 66.6%, an angiotensin II receptor bloker in 26.6%, a calcium channel blocker in 76.6%, a B-blocking agents in 46.6%, an alpha blocker in 13.3%, centrally acting antihypertensive agents 30% and a spirinolactone in 3 cases. One patient underwent a right adrenalectomy with pathological diagnosis concluded an adrenocortical tumor.

Conclusion: Resistant hypertension is quite common. It is mainly due to the age. After confirmation of the diagnosis, it requires a thorough etiologic investigation and appropriate management.