The prevalence of resistant arterial hypertension and secondary causes in a cohort of hypertensive patients: a single center experience

  • Luigi Petramala Departimental Unit of Secondary Hypertension, Department of Internal Medicine and Medical Specialties, Nuclear Medicine Section, Policlinico Umberto I, La Sapienza University, Roma, Italy. http://orcid.org/0000-0003-4397-0624
  • Federica Olmati Departimental Unit of Secondary Hypertension, Department of Internal Medicine and Medical Specialties, Nuclear Medicine Section, Policlinico Umberto I, La Sapienza University, Roma, Italy.
  • Matteo Galassi Departimental Unit of Secondary Hypertension, Department of Internal Medicine and Medical Specialties, Nuclear Medicine Section, Policlinico Umberto I, La Sapienza University, Roma, Italy.
  • Cristiano Marinelli Departimental Unit of Secondary Hypertension, Department of Internal Medicine and Medical Specialties, Nuclear Medicine Section, Policlinico Umberto I, La Sapienza University, Roma, Italy.
  • Antonio Concistrè Departimental Unit of Secondary Hypertension, Department of Internal Medicine and Medical Specialties, Nuclear Medicine Section, Policlinico Umberto I, La Sapienza University, Roma, Italy.
  • Mario Pergolini Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, La Sapienza University, Roma, Italy.
  • Pier Natale Lucia Departimental Unit of Secondary Hypertension, Department of Internal Medicine and Medical Specialties, Nuclear Medicine Section, Policlinico Umberto I, La Sapienza University, Roma, Italy.
  • Giuseppe D'Ermo Department of Surgery P. Valdoni, Nuclear Medicine Section, Policlinico Umberto I, La Sapienza University, Roma, Italy.
  • Umberto Costi Department of Surgery P. Valdoni, Nuclear Medicine Section, Policlinico Umberto I, La Sapienza University, Roma, Italy.
  • Giuseppe De Vincentis Department of Radiology, Nuclear Medicine Section, Policlinico Umberto I, La Sapienza University, Roma, Italy.
  • Gianfranco Tonnarini Departimental Unit of Secondary Hypertension, Department of Internal Medicine and Medical Specialties, Nuclear Medicine Section, Policlinico Umberto I, La Sapienza University, Roma, Italy.
  • Gino Iannucci Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, La Sapienza University, Roma, Italy.
  • Giorgio De Toma Department of Surgery P. Valdoni, Nuclear Medicine Section, Policlinico Umberto I, La Sapienza University, Roma, Italy.
  • Claudio Letizia | claudio.letizia@uniroma1.it Departimental Unit of Secondary Hypertension, Department of Internal Medicine and Medical Specialties, Nuclear Medicine Section, Policlinico Umberto I, La Sapienza University, Roma, Italy. http://orcid.org/0000-0003-4397-0624

Abstract

The prevalence of resistant hypertension (RHT) still remains unknown. Aim of the study was to investigate in a large cohort of hypertensive patients the prevalence of RHT, and to identify in these patients the secondary forms of arterial hypertension (SH). We enrolled a series of 3685 consecutive hypertensive patients. All patients underwent complete physical examination, laboratory tests, screening for SH. Ambulatory blood pressure monitoring (ABPM) was performed to exclude white-coat hypertension. Further, we investigated for any obstructive sleep apnea syndrome (OSA). Only 232 (5.8%) hypertensive patients fulfilled criteria for RHT. 91 (39%) had a SH; 56 (61%) hypertensive patients had a primary aldosteronism, 22 (24%) had OSA, 7 (7.7%) had a hypercortisolism, and 5 (5.5%) had a renovascular hypertension (RVH). Only one patient had adrenal pheochromocytoma. An accurate definition and investigation into RHT is needed. We recommend ABPM to all patients at diagnosis. Finally, all patients must be screened for SH, such as adrenal hypertension, OSA and RVH, especially those who are apparently resistant to polypharmacological treatment.

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Author Biographies

Luigi Petramala, Departimental Unit of Secondary Hypertension, Department of Internal Medicine and Medical Specialties, Nuclear Medicine Section, Policlinico Umberto I, La Sapienza University, Roma
Departimental Unit of Secondary Hypertension, Department of Internal Medicine and Medical Specialties, University of Rome, Sapienza, Italy
Matteo Galassi, Departimental Unit of Secondary Hypertension, Department of Internal Medicine and Medical Specialties, Nuclear Medicine Section, Policlinico Umberto I, La Sapienza University, Roma
Departimental Unit of Secondary Hypertension, Department of Internal Medicine and Medical Specialties, Policlinico “Umberto I”, University of Rome, Sapienza, Italy
Cristiano Marinelli, Departimental Unit of Secondary Hypertension, Department of Internal Medicine and Medical Specialties, Nuclear Medicine Section, Policlinico Umberto I, La Sapienza University, Roma
Departimental Unit of Secondary Hypertension, Department of Internal Medicine and Medical Specialties, University of Rome, Sapienza, Italy
Antonio Concistrè, Departimental Unit of Secondary Hypertension, Department of Internal Medicine and Medical Specialties, Nuclear Medicine Section, Policlinico Umberto I, La Sapienza University, Roma
Departimental Unit of Secondary Hypertension, Department of Internal Medicine and Medical Specialties, Policlinico “Umberto I”, University of Rome, Sapienza, Italy
Mario Pergolini, Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, La Sapienza University, Roma
Professor, Department of Internal Medicine and Medical Specialties, University of Rome, Sapienza, Italy
Pier Natale Lucia, Departimental Unit of Secondary Hypertension, Department of Internal Medicine and Medical Specialties, Nuclear Medicine Section, Policlinico Umberto I, La Sapienza University, Roma
Professor, Department of Internal Medicine and Medical Specialties, University of Rome, Sapienza, Italy
Giuseppe D'Ermo, Department of Surgery P. Valdoni, Nuclear Medicine Section, Policlinico Umberto I, La Sapienza University, Roma
Professor, Department of Surgery P. Valdoni, Policlinico Umberto I, University of Rome, Sapienza
Umberto Costi, Department of Surgery P. Valdoni, Nuclear Medicine Section, Policlinico Umberto I, La Sapienza University, Roma
Professor, Department of Surgery P. Valdoni, Policlinico Umberto I, University of Rome, Sapienza
Giuseppe De Vincentis, Department of Radiology, Nuclear Medicine Section, Policlinico Umberto I, La Sapienza University, Roma
Professor, Department of Radiology, Nuclear Medicine Section; Policlinico Umberto I, University of Rome, "Sapienza", Italy
Gianfranco Tonnarini, Departimental Unit of Secondary Hypertension, Department of Internal Medicine and Medical Specialties, Nuclear Medicine Section, Policlinico Umberto I, La Sapienza University, Roma
Department of Internal Medicine and Medical Specialties, University of Rome, Sapienza, Italy
Gino Iannucci, Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, La Sapienza University, Roma
Professor,Departimental Unit of Secondary Hypertension, Department of Internal Medicine and Medical Specialties, Policlinico “Umberto I”, University of Rome, Sapienza, Italy
Giorgio De Toma, Department of Surgery P. Valdoni, Nuclear Medicine Section, Policlinico Umberto I, La Sapienza University, Roma
Professor, Department of Surgery P. Valdoni, Policlinico Umberto I, University of Rome, Sapienza
Claudio Letizia, Departimental Unit of Secondary Hypertension, Department of Internal Medicine and Medical Specialties, Nuclear Medicine Section, Policlinico Umberto I, La Sapienza University, Roma
Professor, Departimental Unit of Secondary Hypertension, Department of Internal Medicine and Medical Specialties, University of Rome, Sapienza, Italy
Published
2017-11-28
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Original Articles
Keywords:
Resistant hypertension, primary aldosteronism, sleep obstructive apnea, renovascular hypertension, ambulatory blood pressure monitoring.
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How to Cite
Petramala, L., Olmati, F., Galassi, M., Marinelli, C., Concistrè, A., Pergolini, M., Lucia, P. N., D’Ermo, G., Costi, U., De Vincentis, G., Tonnarini, G., Iannucci, G., De Toma, G., & Letizia, C. (2017). The prevalence of resistant arterial hypertension and secondary causes in a cohort of hypertensive patients: a single center experience. Italian Journal of Medicine, 11(4), 380-387. https://doi.org/10.4081/itjm.2017.885