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Cardiac and Vascular Alterations in Resistant Hypertension

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Resistant Hypertension

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Abstract

Cardiovascular complications, such as myocardial infarction, heart failure, stroke, and renal failure, are related to both the degree and the duration of blood pressure increase. Resistant hypertension is associated with a higher risk of cardiovascular complications, as a consequence of target organ damage, including cardiac abnormalities and vascular alterations in the macro- and microvasculature. The relationship between cardiovascular disease and target organ damage can be bidirectional. Elevated blood pressure values in resistant hypertension may cause cardiovascular structural and functional alterations, and the development/persistence of left ventricular hypertrophy, aortic stiffness, atherosclerotic plaques, microvascular disease, and renal dysfunction may render hypertension more difficult to control. Resistant hypertension has been shown to be more strictly related to several conditions, such as obesity, sleep apnea, diabetes, metabolic syndrome, and hyperaldosteronism, characterized by an overexpression of humoral and hormonal factors involved in the development and maintenance of target organ damage .Optimal therapeutic strategies, including pharmacological treatment and innovative invasive methodologies, have been shown to reach adequate blood pressure control and regression of target organ damage, potentially improving patients prognosis.

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References

  1. Calhoun D 1. A, Jones D, Textor S, Goff DC, Murphy TP, Toto RD, et al. (2008) Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation 117:e510–e526

    Google Scholar 

  2. Hall WD (2002) Resistant hypertension, secondary hypertension, and hypertensive crises. Cardiol Clin 20:281–289

    Article  PubMed  Google Scholar 

  3. Pierdomenico SD, Lapenna D, Bucci A, Di Tommaso R, Di Mascio R, Manente BM et al (2005) Cardiovascular outcome in treated hypertensive patients with responder, masked, false resistant, and true resistant hypertension. Am J Hypertens 18:1422–1428

    Article  PubMed  Google Scholar 

  4. Papadopoulos DP, Papademetriou V (2006) Resistant hypertension: diagnosis and management. J Cardiovasc Pharmacol Ther 11:113–118

    Article  PubMed  Google Scholar 

  5. Redon J, Campos C, Narciso ML, Rodicio JL, Pascual JM, Ruilope LM (1998) Prognostic value of ambulatory blood pressure monitoring in refractory hypertension. A prospective study. Hypertension 31:712–718

    Article  PubMed  CAS  Google Scholar 

  6. Daugherty SL, Powers JD, Magid DJ, Tavel HM, Masoudi FA, Margolis KL, O’Connor PJ, Selby JV, Ho PM (2012) Incidence and prognosis of resistant hypertension in hypertensive patients. Circulation 125:1635–1642

    Article  PubMed  Google Scholar 

  7. Guidelines for the Management of Arterial Hypertension (2007) The task force for the management of arterial hypertension of the European society of hypertension (ESH) and of the European society of cardiology (ESC). J Hypertens 25:1105–1187

    Article  Google Scholar 

  8. McAlister FA, Lewanczuk RZ, Teo KK (1996) Resistant hypertension: an overview. Can J Cardiol 12:822–828

    PubMed  CAS  Google Scholar 

  9. Ram CVS (2003) Management of refractory hypertension. Am J Therapeut 10:122–126

    Article  Google Scholar 

  10. Cuspidi C, Macca G, Sampieri L, Michev I, Salerno M, Fusi V, Severgnini B, Meani S, Magrini F, Zanchetti A (2001) High prevalence of cardiac and extracardiac target organ damage in refractory hypertension. J Hypertens 19(11):2063–2070

    Article  PubMed  CAS  Google Scholar 

  11. Cuspidi C, Vaccarella A, Negri F, Sala C (2010) Resistant hypertension and left ventricular hypertrophy: an overview. J Am Soc Hypertens 4(6):319–324

    Article  PubMed  Google Scholar 

  12. Salles G, Leocadio S, Bloch K, Nogueira AR, Muxfeldt E (2005) Combined QT interval and voltage criteria improve left ventricular hypertrophy detection in resistant hypertension. Hypertension 46:1207–1212

    Article  PubMed  CAS  Google Scholar 

  13. Salles G, Cardoso C, Nogueira AR, Bloch K, Muxfeldt E (2006) Importance of the electrocardiographic strain pattern in patients with resistant hypertension. Hypertension 48:437–442

    Article  PubMed  CAS  Google Scholar 

  14. Castelpoggi CH, Pereira VS, Fiszman R, Cardoso CRL, Muxfeldt ES, Salles G (2009) A blunted decrease in nocturnal blood pressure is independently associated with increased aortic stiffness in patients with resistant hypertension. Hypertens Res 32:591–596

    Article  PubMed  Google Scholar 

  15. Salles G, Cardoso CRL, Muxfeldt E (2009) Prognostic value of ventricular repolarization prolongation in resistant hypertension: a prospective cohort study. J Hypertens 27:1094–1101

    Article  PubMed  CAS  Google Scholar 

  16. Salles G, Cardoso CRL, Fiszman R, Muxfeldt ES (2010) Prognostic significance of baseline and serial changes in electrocardiographic strain pattern in resistant hypertension. J Hypertens 28:1715–1733

    Article  PubMed  CAS  Google Scholar 

  17. Salles G, Cardoso CRL, Fiszman R, Muxfeldt ES (2010) Prognostic impact of baseline and serial changes in electrocardiographic left ventricular hypertrophy in resistant hypertension. Am Heart J 159:833–840

    Article  PubMed  Google Scholar 

  18. Hernandez-del Rey R, Armario P, Martin-Baranera M, Sanchez P, Cardenas G, Pardell H (1998) Target-organ damage and cardiovascular risk profile in resistant hypertension. Influence of the white-coat effect. Blood Press Monit 3:331–337

    CAS  Google Scholar 

  19. Armstrong AC, Gidding S, Gjesdal O, Wu C, Bluemke DA, Lima JA (2012) LV mass assessed by echocardiography and CMR, cardiovascular outcomes, and medical practice. JACC Cardiovasc Imaging 5(8):837–848

    Article  PubMed  Google Scholar 

  20. Muiesan ML, Salvetti M, Rizzoni D, Castellano M, Donato F, Agabiti-Rosei E (1995) Association of change in left ventricular mass with prognosis during long-term antihypertensive treatment. J Hypertens 13(10):1091–1095

    Article  PubMed  CAS  Google Scholar 

  21. de Faire U, Lindwall K, Andersson G, Eriksson S (1989) Regression of left ventricular hypertrophy on long-term treatment with captopril of severe hypertensives refractory to standard triple treatment. Eur J Clin Pharmacol 37:291–294

    Article  PubMed  Google Scholar 

  22. Julien J, Dufloux MA, Prasquier R, Chatellier G, Menard D, Plouin PF et al (1990) Effects of captopril and minoxidil on left ventricular hypertrophy in resistant hypertensive patients: a 6 month double-blind comparison. J Am Coll Cardiol 16:137–142

    Article  PubMed  CAS  Google Scholar 

  23. Gaddam K, Corros C, Pimenta E, Ahmed M, Denney T, Aban I et al (2010) Rapid reversal of left ventricular hypertrophy and intracardiac volume in patients with resistant hypertension and hyperaldosteronism. A prospective clinical study. Hypertension 55:1137–1142

    Article  PubMed  CAS  Google Scholar 

  24. Brandt MC, Mahfoud F, Reda S, Schirmer SH, Erdmann E, Böhm M, Hoppe UC (2012) Renal sympathetic denervation reduces left ventricular hypertrophy and improves cardiac function in patients with resistant hypertension. J Am Coll Cardiol 59:901–909

    Article  PubMed  Google Scholar 

  25. Pickering TG (2007) Arterial stiffness as a cause of resistant hypertension? J Clin Hypertens 9:390–395

    Article  Google Scholar 

  26. Spence JD (2000) Management of resistant hypertension in patients with carotid stenosis: high prevalence of renovascular hypertension. Cerebrovasc Dis 10(4):249–254

    Article  PubMed  CAS  Google Scholar 

  27. Schmieder RE, Schmidt BM, Raff U, Bramlage P, Dörfler A, Achenbach S, Schwab J, Kolominsky-Rabas P (2011) Cerebral microangiopathy in treatment-resistant hypertension. Clin Hypertens 13(8):582–587

    Article  Google Scholar 

  28. Figueiredo VN, Yugar-Toledo JC, Martins LC, Martins LB, de Faria AP, de Haro Moraes C, Sierra C, Coca A, Moreno H (2012) Vascular stiffness and endothelial dysfunction: correlations at different levels of blood pressure. Blood Press 21(1):31–38

    Article  PubMed  CAS  Google Scholar 

  29. Rizzoni D, Porteri E, Boari GE et al (2003) Prognostic significance of small-artery structure in hypertension. Circulation 108:2230–2235

    Article  PubMed  Google Scholar 

  30. Rizzoni D, Porteri E, Castellano M, Bettoni G, Muiesan ML, Muiesan P, Giulini SM, Agabiti Rosei E (1996) Vascular hypertrophy and remodeling in secondary hypertension. Hypertension 28:785–790

    Article  PubMed  CAS  Google Scholar 

  31. Rizzoni D, Paiardi S, Rodella L, Porteri E, De Ciuceis C, Rezzani R, Boari GE, Zani F, Miclini M, Tiberio GA, Giulini SM, Rosei CA, Bianchi R, Agabiti Rosei E (2006) Changes in extracellular matrix in subcutaneous small resistance arteries of patients with primary aldosteronism. J Clin Endocrinol Metab 91(7):2638–2642

    Article  PubMed  CAS  Google Scholar 

  32. Schiffrin EL, Deng LY, Sventek P, Day R (1997) Enhanced expression of endothelin-1 gene in resistance arteries in severe human essential hypertension. J Hypertens 15(1):57–63

    Article  PubMed  CAS  Google Scholar 

  33. Muxfeldt ES, Bloch KV, Nogueira Ada R, Salles GF (2005) True resistant hypertension: is it possible to be recognized in the office? Am J Hypertens 18:1534–1540

    Article  PubMed  Google Scholar 

  34. Raff U, Harazny JM, Titze SI, Schmidt BM, Michelson G, Schmieder RE (2012) Salt intake determines retinal arteriolar structure in treatment resistant hypertension independent of blood pressure. Atherosclerosis 222(1):235–240

    Article  PubMed  CAS  Google Scholar 

  35. Rossi GP, Bolognesi M, Rizzoni D, Seccia TM, Piva A, Porteri E, Tiberio GA, Giulini SM, Agabiti-Rosei E, Pessina AC (2008) Vascular remodeling and duration of hypertension predict outcome of adrenalectomy in primary aldosteronism patients. Hypertension 51(5):1366–1371

    Article  PubMed  CAS  Google Scholar 

  36. Muiesan ML, Salvetti M, Zulli R, Pasini GF, Bettoni G, Monteduro C et al (1998) Structural association between the carotid artery and the left ventricle in a general population in Northern Italy: the Vobarno study. J Hypertens 16(Pt 1):1805–1812

    Article  PubMed  CAS  Google Scholar 

  37. Muiesan ML, Salvetti M, Paini A, Monteduro C, Rosei CA, Aggiusti C, Belotti E, Bertacchini F, Galbassini G, Stassaldi D, Castellano M, Rosei EA (2010) Pulse wave velocity and cardiovascular risk stratification in a general population: the Vobarno study. J Hypertens 28:1935–1943

    Article  PubMed  CAS  Google Scholar 

  38. Salvetti M, Muiesan ML, Paini A, Agabiti Rosei C, Aggiusti C, Bertacchini F, Stassaldi D, Beschi F, Cobelli S, Rubagotti G, Monteduro C, Castellano M, Agabiti Rosei E (2011) Resistant hypertension in a general population in Northern Italy: prevalence, associated cardiovascular risk factors and target organ damage. J Hypertens 29 (suppl A) 42.362. (abst)

    Google Scholar 

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Authors and Affiliations

  1. Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, c/o 2a Medicina, Spedali Civili di Brescia, 25100, Brescia, Italy

    Enrico Agabiti Rosei, Maria Lorenza Muiesan & Damiano Rizzoni

Authors
  1. Enrico Agabiti Rosei
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  2. Maria Lorenza Muiesan
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  3. Damiano Rizzoni
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Correspondence to Enrico Agabiti Rosei .

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Editors and Affiliations

  1. IRCCS Istituto Auxologico Italiano, University of Milano Bicocca, Milan, Italy

    Giuseppe Mancia

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Agabiti Rosei, E., Muiesan, M.L., Rizzoni, D. (2013). Cardiac and Vascular Alterations in Resistant Hypertension. In: Mancia, G. (eds) Resistant Hypertension. Springer, Milano. https://doi.org/10.1007/978-88-470-5415-8_4

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  • DOI: https://doi.org/10.1007/978-88-470-5415-8_4

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  • Online ISBN: 978-88-470-5415-8

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