Volume 115, Nº 1, July 2020
DOI: https://doi.org/10.36660/abc.20190218
ORIGINAL ARTICLE
Clinical Characteristics of Resistant vs. Refractory Hypertension in a Population of Hypertensive Afrodescendants
Cristiano Macedo
Roque Aras Junior
Isabella Sales de Macedo
Figure 1 – Proportion of use of antihypertensive medication, according to resistant or refractory hypertension. ACEI: angiotensin-converting enzyme inhibitor; BRA: angiotensin receptor blocker; BCC: calcium channel blocker ; B-Block: beta blocker; RH: resistant hypertension; HRf: refra ctory hypertension.
Abstract
Background: Afrodescendants have been associated with a greater severity of arterial hypertension and a higher incidence of cardiovascular complications. Characteristics in the presentation of resistant hypertension (RH) or refractory hypertension (RfH), specifically in this ethnic group, have not been properly studied.
Objectives: The study compares clinical and epidemiological characteristics and prevalence of cardiovascular events in people of African descent diagnosed with RH or RfH.
Methods: Cross-sectional study carried out in a referral clinic for patients with severe hypertension. The level of significance was 5%.
Results: 146 consecutive patients were evaluated, of which 68.7% were female. The average age was 61.8 years, with 88.4% of Afrodescendants (mixed race or black). 51% had RfH. There was a high prevalence of cardiovascular risk factors: 34.2% of subjects had diabetes, 69.4% dyslipidemia, 36.1% obesity, and 38.3% history of smoking. Reduced renal function was seen in 34.2%. Previous cardiovascular events occurred in 21.8% for myocardial infarction and in 19.9% for stroke. The Framingham’s risk score was moderate/high at 61%. RfH patients were younger (mean age 59.38±11.69 years versus 64.10±12.23 years, p=0.02), had more dyslipidemia (83.8 versus 66.7%, p=0.021), and stroke (30.4 versus 12.3%, p=0.011) when compared to those with RH. The use of a combination of ACEi/ARB+CCB+Diuretic, chlortalidone and spironolactone was also more frequent in individuals with RfH.
Conclusion: Africandescendant people with RH had a high cardiovascular risk, a high prevalence of RfH, a higher frequency of dyslipidemia and stroke, compatible with a high incidence of injury to target organs. (Arq Bras Cardiol. 2020; 115(1):31-39)
Keywords: Hypertension/complications; African Continental Ancestry Grup/genetic; Comparative Stuy; Epidemiology;Myocardial Infarction; Stroke.
