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Antihypertensive drug use in resistant and nonresistant hypertension and in controlled and uncontrolled resistant hypertension

de la Sierra, Alejandroa; Armario, Pedrob; Oliveras, Annac; Banegas, José, R.d; Gorostidi, Manuele; Vinyoles, Ernestf; de la Cruz, Juan, J.d; Segura, Juliáng; Ruilope, Luis, M.g

doi: 10.1097/HJH.0000000000001729
ORIGINAL PAPERS: Resistant hypertension

Background and aim: 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.

Methods: 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.

Results: 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).

Conclusion: 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:,

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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