Treatment-resistant hypertension (TRH) is associated with particular clinical features, nonadherence, and suboptimal treatment. We assessed possible associations of antihypertensive drug classes, specific agents inside each class, and types of combinations, with the presence of non-TRH vs. TRH, and with controlled vs. uncontrolled TRH.
Comparisons were done in 14 264 patients treated with three drugs (non-TRH: 2988; TRH: 11 276) and in 6974 treated with at least four drugs (controlled TRH: 1383; uncontrolled TRH: 5591). Associations were adjusted for age, sex, and previous cardiovascular event.
In both groups of patients treated with three or with at least four drugs, aldosterone antagonists among drug classes [adjusted odds ratio (OR): 1.82 and 1.41, respectively], and ramipril (OR: 1.28 and 1.30), olmesartan (OR: 1.31 and 1.37), and amlodipine (OR: 1.11 and 1.41) inside each class were significantly associated with blood pressure control (non-TRH or controlled TRH). In patients treated with three drugs, non-TRH was also associated with the use of chlorthalidone (OR: 1.50) and bisoprolol (OR: 1.19), whereas in patients treated with at least four drugs, controlled TRH was significantly associated with the triple combination of a renin–angiotensin system blocker, a calcium channel blocker, and a diuretic (OR: 1.17).
The use of aldosterone antagonists is associated with blood pressure control in patients treated with three or more drugs. Similar results are observed with specific agents inside each class, being ramipril, olmesartan, chlorthalidone, amlodipine, and bisoprolol those exhibiting significant results. An increased use of these drugs might probably reduce the burden of TRH.
aDepartment of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona
bDepartment of Internal Medicine, Cardiovascular Risk Area, Hospital Moisès Broggi
cHypertension Unit, Department of Nephrology, Hospital del Mar, Barcelona
dDepartment of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid
eDepartment of Nephrology, Hospital Universitario Central de Asturias, RedinRen, Oviedo
fPrimary Care Centre La Mina, Barcelona
gHypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain
Correspondence to Alejandro de la Sierra, MD, Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Plaza Dr Robert, 5, 08221 Terrassa, Barcelona, Spain. Tel: +34 937365000x1295; fax: +34 937365037; e-mail: firstname.lastname@example.org, email@example.com
Abbreviations: ABPM, ambulatory blood pressure monitoring; ACEi, angiotensin converting enzyme inhibitor; ARBAT1, blocker; BP, blood pressure; CCB, calcium channel blocker; DRI, direct renin inhibitor; OR, odds ratio; RAS, renin–angiotensin system; TRH, treatment-resistant hypertension
Received 12 December, 2017
Revised 15 January, 2018
Accepted 23 February, 2018
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