Endocrine Abstracts

Objective: to conduct a comparative assessment between metabolic and hemodynamic parameters in obese patients with true and pseudo-resistant (due to different causes) hypertension.

Materials and methods: The study included 302 patients with uncontrolled hypertension and obesity. Initial treatment efficacy was assessed 3 months after dual therapy was administered. Those patients who did not reach target blood pressure (BP) in dual therapy were transferred to triple therapy. Among patients who received triple therapy, 69 people did not reach target BP (they received the fourth drug spironolactone). All patients were additionally examined 6 months after the initiation of antihypertensive therapy.

Results: A comparative assessment of office BP, ambulatory BP monitoring (ABPM) and home self-measurement of BP was carried out between non-resistant and resistant patients: at the initial stage of enrolling patients, there was no significant difference in BP levels between non-resistant and subsequently resistant patients; after 3 months of follow-up (after prescribing double fixed combinations), there was a significant difference in the indicators of both office and out-of-office BP in resistant and non-resistant patients; despite the achievement of target BP levels after 6 months of therapy (double or triple fixed combinations in non-resistant patients and triple therapy + spironolactone in resistant patients), in the presence of resistance, both office, home and most ABPM indicators were significantly higher than in non-resistant patients. If at the stage of enrolling patients into the study and 3 months after the start of therapy there was no significant difference in BP levels between patients with true and pseudo-resistance, then after 6 months of antihypertensive therapy, patients with true resistance had significantly higher levels of office systolic BP (SBP, P < 0.01) and 24 h average SBP according to ABPM data (P < 0.05) compared with pseudo-resistant patients. Obese patients with true resistance had also significantly lower body mass index (BMI) and low-density lipoprotein cholesterol (LDL-cholesterol, P < 0.05) as well as higher levels of aldosterone and SBP (P < 0.05) compared with pseudo-resistant patients.

Conclusions: Even when target BP levels in antihypertensive therapy are achieved, obese resistant patients are characterized by higher levels of office and out-of-office BP, compared with non-resistant patients. Compared with pseudo-resistance, the presence of true resistance in obesity is associated with higher SBP and aldosteron levels, as well as lower BMI and LDL-cholesterol.