Arterial hypertension accounts for, or contributes to, 62% of all strokes and 49% of all cases of heart disease. Most cases of hypertension can be effectively treated with lifestyle changes and/or medications, but within this population lies a cohort at the upper end of the cardiovascular risk spectrum – those with hypertension resistant to treatment. Resistant hypertension is currently defined as a raised blood pressure (seated clinic blood pressure greater than 140 mmHg systolic and 90 mmHg diastolic) despite treatment with at least three antihypertensive agents (one of which is a diuretic) at optimal or best tolerated doses. The challenges of determining, within this population, white coat hypertension and medication adherence are significant.
Pimenta and Calhoun (2012) suggested the prevalence of resistant hypertension to be between 15% and 30% of treated hypertensive patients. They, together with the American Heart Association (2008) and the UK National Institute for Health and Care Excellence (2011), suggest the need for further research into the prevalence, prognosis and management of patients with resistant hypertension. With HRB funding, we confirmed the feasibility of pragmatically identifying patients with resistant hypertension using a specially developed remote software tool. The overall aim of the project is to
(a) perform a systematic review of the global evidence describing the prevalence of resistant hypertension as defined by the AHA
and utilising the specially developed remote software tool in 100 Irish general practices to
(b) pragmatically determine the prevalence of resistant hypertension
(c) determine the prognosis of these patients over two years
and with ten Irish general practices, in collaboration with a hospital Resistant Hypertension Clinic, to
(d) describe the detailed cardiovascular phenotype of such patients focusing on ambulatory blood pressure monitoring and adherence, including toxicological urinalysis
(e) develop a platform cohort of patients with confirmed resistant hypertension suitable for future research.
