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The prevalence of resistant arterial hypertension and secondary causes in a cohort of hypertensive patients: a single center experience

Luigi Petramala, Federica Olmati, Matteo Galassi, Cristiano Marinelli, Antonio Concistrè, Mario Pergolini, Pier Natale Lucia, Giuseppe D'Ermo, Umberto Costi, Giuseppe De Vincentis, Gianfranco Tonnarini, Gino Iannucci, Giorgio De Toma, Claudio Letizia
  • Luigi Petramala http://orcid.org/0000-0003-4397-0624
    Departimental Unit of Secondary Hypertension, Department of Internal Medicine and Medical Specialties, Nuclear Medicine Section, Policlinico Umberto I, La Sapienza University, Roma, Italy
  • Federica Olmati
    Departimental Unit of Secondary Hypertension, Department of Internal Medicine and Medical Specialties, Nuclear Medicine Section, Policlinico Umberto I, La Sapienza University, Roma, Italy
  • Matteo Galassi
    Departimental Unit of Secondary Hypertension, Department of Internal Medicine and Medical Specialties, Nuclear Medicine Section, Policlinico Umberto I, La Sapienza University, Roma, Italy
  • Cristiano Marinelli
    Departimental Unit of Secondary Hypertension, Department of Internal Medicine and Medical Specialties, Nuclear Medicine Section, Policlinico Umberto I, La Sapienza University, Roma, Italy
  • Antonio Concistrè
    Departimental Unit of Secondary Hypertension, Department of Internal Medicine and Medical Specialties, Nuclear Medicine Section, Policlinico Umberto I, La Sapienza University, Roma, Italy
  • Mario Pergolini
    Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, La Sapienza University, Roma, Italy
  • Pier Natale Lucia
    Departimental Unit of Secondary Hypertension, Department of Internal Medicine and Medical Specialties, Nuclear Medicine Section, Policlinico Umberto I, La Sapienza University, Roma, Italy
  • Giuseppe D'Ermo
    Department of Surgery P. Valdoni, Nuclear Medicine Section, Policlinico Umberto I, La Sapienza University, Roma, Italy
  • Umberto Costi
    Department of Surgery P. Valdoni, Nuclear Medicine Section, Policlinico Umberto I, La Sapienza University, Roma, Italy
  • Giuseppe De Vincentis
    Department of Radiology, Nuclear Medicine Section, Policlinico Umberto I, La Sapienza University, Roma, Italy
  • Gianfranco Tonnarini
    Departimental Unit of Secondary Hypertension, Department of Internal Medicine and Medical Specialties, Nuclear Medicine Section, Policlinico Umberto I, La Sapienza University, Roma, Italy
  • Gino Iannucci
    Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, La Sapienza University, Roma, Italy
  • Giorgio De Toma
    Department of Surgery P. Valdoni, Nuclear Medicine Section, Policlinico Umberto I, La Sapienza University, Roma, Italy

Abstract

The prevalence of resistant hypertension (RHT) still remains unknown. Aim of the study was to investigate in a large cohort of hypertensive patients the prevalence of RHT, and to identify in these patients the secondary forms of arterial hypertension (SH). We enrolled a series of 3685 consecutive hypertensive patients. All patients underwent complete physical examination, laboratory tests, screening for SH. Ambulatory blood pressure monitoring (ABPM) was performed to exclude white-coat hypertension. Further, we investigated for any obstructive sleep apnea syndrome (OSA). Only 232 (5.8%) hypertensive patients fulfilled criteria for RHT. 91 (39%) had a SH; 56 (61%) hypertensive patients had a primary aldosteronism, 22 (24%) had OSA, 7 (7.7%) had a hypercortisolism, and 5 (5.5%) had a renovascular hypertension (RVH). Only one patient had adrenal pheochromocytoma. An accurate definition and investigation into RHT is needed. We recommend ABPM to all patients at diagnosis. Finally, all patients must be screened for SH, such as adrenal hypertension, OSA and RVH, especially those who are apparently resistant to polypharmacological treatment.

Keywords

Resistant hypertension; primary aldosteronism; sleep obstructive apnea; renovascular hypertension; ambulatory blood pressure monitoring.

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Submitted: 2017-04-28 12:05:20
Published: 2017-11-28 14:02:11
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Copyright (c) 2017 Luigi Petramala, Federica Olmati, Matteo Galassi, Cristiano Marinelli, Antonio Concistrè, Mario Pergolini, Pier Natale Lucia, Giuseppe D'Ermo, Umberto Costi, Giuseppe De Vincentis, Gianfranco Tonnarini, Gino Iannucci, Giorgio De Toma, Claudio Letizia

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