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Prevalence and clinical characteristics of patients with true resistant hypertension in central and Eastern Europe: data from the BP-CARE study

Brambilla, Gianmariaa; Bombelli, Michelea; Seravalle, Ginob; Cifkova, Renatac; Laurent, Stephaned; Narkiewicz, Krzysztofe; Facchetti, Ritaa; Redon, Josepf; Mancia, Giuseppeb; Grassi, Guidoa,g

doi: 10.1097/HJH.0b013e328363823f
ORIGINAL PAPERS: Resistant hypertension

Objective: Scanty information is available on the clinical characteristics of resistant hypertension in Central and East European countries. The Blood Pressure (BP) control rate and CArdiovascular Risk profilE (BP-CARE) study allowed us to assess the prevalence and the main clinical features of resistant hypertension in this population.

Design and method: The study was carried out in 1312 treated hypertensive patients living in nine Central and East European countries.

Results: Four hundred and twenty-three patients had apparent resistant hypertension, of whom 168 had pseudo-resistant hypertension (noncompliant/white-coat) and 255 were true treatment-resistant hypertension patients (TRH). Clinical BP values in TRH amounted to 157.4 ± 16.9/91.8 ± 10.0 mmHg despite the daily use of 3.6 ± 0.7 drugs. Their 24-h BP values were 149.5 ± 16.5/97.5 ± 9.8 mmHg. Compared to controlled hypertensive patients (n = 368) and uncontrolled nonresistant hypertensive patients (n = 521), TRH were older with a greater prevalence of women. They showed a higher rate of previous cardiovascular events and a very high cardiovascular risk profile. Estimated glomerular filtration rate was significantly lower in TRH as compared to controlled hypertensive patients and uncontrolled nonresistant hypertensive patients. Overall, target organ damage was more frequently detected in TRH than in controlled hypertensive patients and uncontrolled nonresistant hypertensive patients. The factor most frequently associated with TRH was severity of hypertension followed by age, total cholesterol, BMI and history of heart failure.

Conclusions: The present study provides evidence that the prevalence of TRH in Central and East European countries is similar to that found in Western Europe and USA. It also shows the very high cardiovascular risk of TRH and the elevated association of this condition with obesity, renal failure, organ damage and history of cardiovascular events.

aClinica Medica, Università Milano-Bicocca, Ospedale San Gerardo dei Tintori, Monza

bIstituto Auxologico Italiano, Ospedale San Luca, Milan, Italy

cCenter for Cardiovascular Prevention, Thomayer Hospital and Department of Preventive Cardiology, Institute of Clinical and Experimental Medicine, Prague, Czech Republic

dPharmacology Department and INSERM U970 Hopital Europeen Georges Pompidou, Assistance-Publique Hopitaux de Paris, Paris-Derscartes University, France

eDepartment of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland

fInternal Medicine, Hospital Clinico, University of Valencia, Valencia, Spain

gIRCCS MultiMedica, Sesto San Giovanni, Milan, Italy

Correspondence to Professor Guido Grassi, Clinica Medica, Università Milano-Bicocca, Ospedale San Gerardo, Via Pergolesi 33, 20900 Monza (MB), ItalyTel: +39 039 233 3357; fax: +39 039 322 274; e-mail:

Abbreviations: BP, blood pressure; BP-CARE, Blood Pressure rate control and CArdiovascular Risk profilE; MDRD, Modification of Diet in Renal Disease formula; TRH, true treatment-resistant hypertension patients

Received 21 February, 2013

Revised 8 May, 2013

Accepted 22 May, 2013

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins