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Prevalence of potential modifiable factors of hypertension in patients with difficult-to-control hypertension

Van Der Sande, Nicolette G.C.a,b; Blankestijn, Peter J.b; Visseren, Frank L.J.a; Beeftink, Martine M.c; Voskuil, Michielc; Westerink, Jana; Bots, Michiel L.d; Spiering, Wilkoa

doi: 10.1097/HJH.0000000000001885
ORIGINAL PAPERS: Therapeutic aspects

Background: A comprehensive diagnostic evaluation of potential modifiable factors of difficult-to-control hypertension would enable clinicians to target-specific amendable causes. Therefore, we assessed the prevalence of underlying medical conditions, lifestyle factors, and concomitant medication use in an integrated diagnostic evaluation in patients with difficult-to-control hypertension, referred to a tertiary center.

Methods: The study population consisted of 653 patients referred between 2006 and 2016 for difficult-to-control hypertension to the University Medical Center Utrecht. Difficult-to-control hypertension was defined by not reaching blood pressure (BP) goals despite BP-lowering drug use, or high office BP (>160/100 mmHg) without BP-lowering drug use. Patients were evaluated according to a highly standardized protocol including 24-h ambulatory blood measurements after cessation of BP-lowering drugs, 24-h urine sample, and a isotonic (0.9%) saline infusion test.

Results: In 621 patients (95%) one or more modifiable factors related to hypertension were identified (mean 2.1, SD 1.1). Obesity-related insulin resistance was the most common underlying medical condition which was diagnosed in 130 patients (20%). Primary aldosteronism was diagnosed in 40 patients (6%) and obstructive sleep apnea in 17 patients (3%). Sodium intake was deemed to high (urinary excretion of >6 g/day) in 433 patients (66%). In total, 283 patients (43%) were physical inactive (<30 min/day, during 5 days/week). Oral contraceptive-related hypertension was diagnosed in 10 women (3% of women).

Conclusion: In patients with difficult-to-control hypertension there is a high prevalence of potential modifiable factors related to hypertension, highlighting the importance for an integrated diagnostic evaluation.

aDepartment of Vascular Medicine

bDepartment of Nephrology and Hypertension

cDepartment of Cardiology

dJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands

Correspondence to Wilko Spiering, Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands. Tel: +31 88 7571188; e-mail:

Abbreviations: ABPM, ambulatory blood pressure monitoring; eGFR, estimated glomerular filtrations rate

Received 1 February, 2018

Revised 10 June, 2018

Accepted 4 July, 2018

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