Improved Understanding and Innovative Approaches for an Aging Dilemma: Resistant Hypertension in Women with Existing Vascular Disease
- 69 Downloads
Approximately half of adults with hypertension in the United States are uncontrolled and perhaps, based on most recent data, 12 %–15 % are considered resistant. Moreover, compared with men, women have more prevalent resistant hypertension with greater older age status and obesity, 2 of the strongest predictors. Resistant hypertension is more common in African Americans and more frequent with concomitant heart disease, heart failure, diabetes, stroke, and chronic kidney disease. In addition to lifestyle modifications, effective treatment mandates combination therapy, including appropriate diuretics, renin-angiotensin system blockers, calcium channel blockers, and underutilized aldosterone antagonists. Emerging, innovative interventions, including renal artery denervation and carotid stimulation treatment, are potentially effective and well-tolerated approaches to blood pressure control.
KeywordsResistant Hypertension Women Disparities Cardiovascular disease Treatment African American
K.C. Ferdinand: consultancy for Astra Zeneca, Merck, Takeda, Novartis, and Forest, received honoraria from Daiichi Sankyo, Takeda, Novartis, Forest, and Astra Zeneca; S.A. Nasser: none.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.Signs V. Prevalence, treatment, and control of hypertension– United States, 1999–2002 and 2005–2008. Morb Mortal Wkly Rep (MMWR). 2011;60:103–8.Google Scholar
- 2.• Centers for Disease Control and Prevention. CDC Health Disparities and Inequalities Report - United States, 2011. MMWR. 2011;60:1–116. This report contains important epidemiologic considerations specific to hypertension and disparities. Google Scholar
- 3.A population-based policy and systems change approach to prevent and control hypertension. Washington, DC: The National Academies Press, Institute of Medicine (IOM). 2010.Google Scholar
- 5.•• Mosca L, Benjamin EJ, Berra K. American Heart Association. Effectiveness-based guidelines for the prevention of cardiovascular disease in women--2011 update: a guideline from the American Heart Association. J Am Coll Cardiol. 2011; 57:1404–23. This guideline contains good concepts on CVD/HTN specifically in women and has important epidemiologic concepts as well as treatment considerations in high-risk women. PubMedCrossRefGoogle Scholar
- 6.•• Calhoun DA, Jones D, Textor S, Goff DC, Murphy TP, Toto RD, et al. 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. Hypertension. 2008;51:1403–19. This statement paper develops our understanding of the risk factors and causes of resistant hypertension thus allowing for improved prevention and/or treatment options to improve clinical management of this disorder.PubMedCrossRefGoogle Scholar
- 7.Pimenta E, Calhoun DA. Resistant hypertension: Incidence, prevalence and prognosis. Circulation. 2012 (Epub ahead of print).Google Scholar
- 9.Daugherty SL, Powers JD, Magid DJ, Tavel HM, Masoudi FA, Margolis KL, et al. Incidence and prognosis of resistant hypertension in hypertensive patients. Circulation. 2012 (Epub ahead of print).Google Scholar
- 12.Aronow WS, Fleg JL, Pepine CJ, Artinian NT, Bakris G, Brown AS, et al. ACCF/AHA 2011 expert consensus document on hypertension in the elderly: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents developed in collaboration with the American Academy of Neurology, American Geriatrics Society, American Society for Preventive Cardiology, American Society of Hypertension, American Society of Nephrology, Association of Black Cardiologists, and European Society of Hypertension. J Am Soc Hypertens. 2011;5:259–352.PubMedCrossRefGoogle Scholar
- 13.Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, et al. Heart disease and stroke statistics–2012 Update: A Report From the American Heart Association. Circulation. 2012;125:e2–220.Google Scholar
- 15.Pedrosa RP, Drager LF, Gonzaga CC, Sousa MG, de Paula LK, Amaro AC, et al. Obstructive sleep apnea: The most common secondary cause of hypertension associated with resistant hypertension. Hypertension. 2011;58:811–7.Google Scholar
- 18.Campos-Rodriguez F, Martinez-Garcia MA, de la Cruz-Moron I, Almeida-Gonzalez C, Catalan-Serra P, Montserrat JM. Cardiovascular mortality in women with obstructive sleep apnea with or without continuous positive airway pressure treatment: a cohort study. Ann Intern Med. 2012;156:115–22.Google Scholar
- 19.Tsioufis C, Kordalis A, Flessas D, Anastasopoulos I, Tsiachris D, Papademetriou V, Stefanadis C. Pathophysiology of resistant hypertension: the role of sympathetic nervous system. Int J Hypertens. 2011;642416.Google Scholar
- 20.Milliez P, Girerd X, Plouin PF, Blacher J, Safar ME, Mourad JJ. Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism. J Am Coll Cardiol. 2005;45:1243–8.Google Scholar
- 21.Harrison’s Practice. Hyperaldosteronism. Last updated: May 19, 2010. Available at: http://www.harrisonspractice.com/practice/ub/view/Harrisons%20Practice/141325/0.1/hyperaldosteronism Accessed October 19, 2011.
- 22.Llisterri Caro JL, Barrios Alonso V, de la Sierra Iserte A, Escobar Cervantes C, González-Segura Alsina D. [Prevalence of chronic kidney disease in hypertensive women aged 64 years treated in primary care. MERICAP Study.] Med Clin (Barc). 2011 (Epub, ahead of print).Google Scholar
- 23.Prevalence of chronic kidney disease and associated risk factors—United States, 1999–2004. MMWR. 2007;56:161–5.Google Scholar
- 24.Masoomi M, Azimzadeh BS, Nosrati SN, Raissi A. Prevalence of renal artery stenosis in hypertensive patients undergoing coronary angiography. ARYA Jl. 2006;2:23–6.Google Scholar
- 25.Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2011.Google Scholar
- 26.Hermida RC, Ayala DE, Calvo C, López JE, Mojón A, Fontao MJ, et al. Effects of time of day of treatment on ambulatory blood pressure pattern of patients with resistant hypertension. Hypertension. 2005;46:1053–9.Google Scholar
- 27.Fagard RH, Thijs L, Staessen JA, Clement DL, De Buyzere ML, De Bacquer DA. Night-day blood pressure ratio and dipping pattern as predictors of death and cardiovascular events in hypertension. Hum Hypertens. 2009;23:645–53.Google Scholar
- 28.Thoenes M, Neuberger HR, Volpe M, Khan BV, Kirch W, Böhm M. Antihypertensive drug therapy and blood pressure control in men and women: an international perspective. Hum Hypertens. 2010;24:336–44.Google Scholar
- 30.Margolis KL, Martin LW, Ray RM, Kerby TJ, Allison MA, Curb JD, et al. A prospective study of serum 25-hydroxyvitamin D levels, blood pressure, and incident hypertension in postmenopausal women. Am J Epidemiol. 2012;175:22–32.Google Scholar
- 33.Smith SC Jr, Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA, et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 Update: A Guideline From the American Heart Association and American College of Cardiology Foundation. Circulation. 2011;58:2432–46.Google Scholar
- 34.Morbidity and Mortality Weekly Report (MMWR). Vital Signs: food categories contributing the most to sodium consumption—United States, 2007–2008. 2012;61:92–8.Google Scholar
- 35.Pojoga LH, Williams JS, Yao TM, Kumar A, Raffetto JD, do Nascimento GR, et al. Histone demethylase LSD1 deficiency during high salt diet is associated with enhanced vascular contraction, altered NO-cGMP relaxation pathway, and hypertension. Am J Physiol Heart Circ Physiol. 2011;301:H1862–71.Google Scholar
- 36.•• Flack JM, Sica DA, Bakris G, Brown AL, Ferdinand KC, Grimm RH Jr, et al. International Society on Hypertension in Blacks. Management of high blood pressure in Blacks: an update of the International Society on Hypertension in Blacks consensus statement. Hypertension. 2010;56:780–800. This statement provides an excellent tool on methods of treating resistant hypertension, specifically from an African American standpoint. PubMedCrossRefGoogle Scholar
- 37.DeMarco MA, Maynard JW, Huizinga MM, Baer AN, Köttgen A, Gelber AC, et al. Diuretic use, increased serum urate levels, and risk of incident gout in a population-based study of adults with hypertension: The Atherosclerosis Risk in Communities cohort study. Arthritis Rheum. 2012;64:121–9.CrossRefGoogle Scholar
- 39.Kostis JB, Cabrera J, Cheng JQ, Cosgrove NM, Deng Y, Pressel SL, et al. Association between chlorthalidone treatment of systolic hypertension and long-term survival. JAMA. 2011;306:2588–93.Google Scholar
- 40.The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002;288:2981–97.CrossRefGoogle Scholar
- 41.Cushman WC, Davis BR, Pressel SL, Cutler JA, Einhorn PT, Ford CE, et al. Mortality and Morbidity During and After the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. J Clin Hypertens. 2012;14:20–31.Google Scholar
- 42.Vaclavik J, Sedlak R, Plachy M, Navratil K, Plasek J, Husar R, et al. Addition of spironolactone in patients with resistant arterial hypertension (ASPIRANT): a randomized, double-blind, placebo-controlled trial. Hypertension. 2011;57:1069–75.Google Scholar
- 44.Hanselin MR, Saseen JJ, Allen RR, Marrs JC, Nair KV. Description of antihypertensive use in patients with resistant hypertension prescribed four or more agents. Hypertension. 2011;58:1008–13.Google Scholar
- 46.Polypill website. Available at: www.polypillrx.com Accessed March 26, 2012.
- 47.Gaddam KK, Nishizaka MK, Pratt-Ubunama MN, Pimenta E, Aban I, Oparil S, et al. Characterization of resistant hypertension: association between resistant hypertension, aldosterone, and persistent intravascular volume expansion. Arch Intern Med. 2008;168:1159–64.Google Scholar
- 48.Ferrario CM, Flack JM, Strobeck JE, Smits G, Peters C. Individualizing hypertension treatment with impedance cardiography: a meta-analysis of published trials. Ther Adv Cardiovasc Dis. 2010;4:5–16.Google Scholar
- 49.Hermida RC, Ayala DE, Mojon A, Fernandez JR. Influence of circadian time of hypertension treatment on cardiovascular risk: results of the MAPEC study. Chronobiol Int. 2010;27:162–1651.Google Scholar
- 51.Witkowski A, Prejbisz A, Florczak E, Kądziela J, Śliwiński P, Bieleń P, et al. Effects of renal sympathetic denervation on blood pressure, sleep apnea course, and glycemic control in patients with resistant hypertension and sleep apnea. Hypertension. 2011;58:559–65.Google Scholar
- 52.• Brandt MC, Mahfoud F, Reda S, Schirmer SH, Erdmann E, Böhm M, et al. Renal sympathetic denervation reduces left ventricular hypertrophy and improves cardiac function in patients with resistant hypertension. J Am Coll Cardiol. 2012;59:901–9. This article demonstrates the target organ benefits post-renal sympathetic denervation, beyond blood pressure reduction alone. PubMedCrossRefGoogle Scholar
- 53.The REALISE trial. Available at: http://clinicaltrialsfeeds.org/clinical-trials/show/NCT01529372 Accessed: March 31, 2012.
- 54.Vessix Vascular. Available at: http://www.crtonline.org/pr.aspx?PAGE_ID=9536 Accessed March 31, 2012.
- 55.Bertog SC, Sobotka PA, Sievert H. Renal denervation for hypertension. J Am Coll Cardiol Intv. 2012;5:249–58.Google Scholar
- 56.Heusser K, Tank J, Engeli S, Diedrich A, Menne J, Eckert S, et al. Carotid baroreceptor stimulation, sympathetic activity, baroreflex function, and blood pressure in hypertensive patients. Hypertension. 2010;55:619–26.Google Scholar
- 57.Bisognano JD, Bakris G, Nadim MK, Sanchez L, Kroon AA, Schafer J, et al. Baroreflex activation therapy lowers blood pressure in patients with resistant hypertension: results from the double-blind, randomized, placebo-controlled rheos pivotal trial. J Am Coll Cardiol. 2011;58:765–73.Google Scholar
- 58.• Bakris GL, Nadim MK, Haller H, Lovett EG, Schafer JE, Bisognano JD. Baroreflex activation therapy provides durable benefit in patients with resistant hypertension: results of long-term follow-up in the Rheos Pivotal Trial. J Am Soc Hypertens. 2012;6:152–8. The long-term effects of Baroreflex Activation Therapy is documented in this article. PubMedCrossRefGoogle Scholar
- 59.CVRx, Barostim neo. Available at: http://www.cvrx.com/int/second-generation/ Accessed March 31, 2012.