Importance of thorough investigation of resistant hypertension before renal denervation: should compliance to treatment be evaluated systematically?
Language English Country Great Britain, England Media print-electronic
Document type Journal Article, Research Support, Non-U.S. Gov't
PubMed
24500722
DOI
10.1038/jhh.2014.3
PII: jhh20143
Knihovny.cz E-resources
- MeSH
- Medication Adherence * MeSH
- Blood Pressure Monitoring, Ambulatory MeSH
- Antihypertensive Agents therapeutic use MeSH
- Autonomic Denervation methods MeSH
- Adult MeSH
- Hypertension diagnosis drug therapy physiopathology surgery MeSH
- Referral and Consultation MeSH
- Blood Pressure drug effects MeSH
- Kidney innervation MeSH
- Drug Resistance * MeSH
- Middle Aged MeSH
- Humans MeSH
- Drug Monitoring MeSH
- Hospitals, University MeSH
- Predictive Value of Tests MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Eligibility Determination MeSH
- Patient Selection MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Czech Republic MeSH
- Names of Substances
- Antihypertensive Agents MeSH
Catheter-based renal denervation (RD) has been introduced recently as a potentially effective invasive treatment of refractory hypertension. The proportion of patients with severe hypertension suitable for RD is not clear. The aim of this study was to identify what percentage of patients has truly resistant essential hypertension and are thus potentially eligible for RD. We investigated 205 consecutive patients referred to a university hypertension center for severe hypertension within 12 months. Ambulatory 24-h blood pressure (BP) monitoring (24 h ABPM), secondary hypertension screening and compliance to treatment testing (by use of plasma drug level measurements) were performed in all patients. Fifty-seven patients (27.8%) did not have truly resistant hypertension (RH) based on clinical BP. Among the remaining 122 patients (59.5%) with RH confirmed by 24 h ABPM, 50 patients (24.4% of the original cohort) had a secondary cause of hypertension and in 27 (13.2%) non-compliance to treatment was confirmed. Thus, only 45 patients (22%) had truly resistant essential hypertension and were considered for RD. Only one-third (n=15, 7.3% of the original cohort) was, however, finally referred for RD (14 were excluded due to contraindications for RD and 16 refused the invasive treatment). In conclusion, thorough examination of severe hypertension including 24 h ABPM, secondary hypertension exclusion and drug compliance testing before considering RD reveals that majority of these patients are not suitable for RD. Specifically, compliance to treatment testing should be mandatory in order to identify eligible candidates for RD.
Cardiocentre 3rd Faculty of Medicine Charles University Prague Czech Republic
Department of Medicine University of Mississippi Medical Center Jackson MS USA
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