Marco Pappaccogli1,2, Silvia Di Monaco1, Georges Coralie2, Géraldine Petit3, Elisabetta Eula1, Sabrina Ritscher4, Jean-Philippe Lengelé2,5, Elvira Fanelli1, Francesca Severino2, Jean Renkin2,6, Valeria Avataneo7, Pierre Wallemacq8,9, Stefan W Toennes4, Philippe de Timary3, Franco Rabbia1, Alexandre Persu2,6. 1. Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Turin , Turin , Italy. 2. Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels , Belgium. 3. Adult Psychiatry Department and Institute of Neuroscience, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels , Belgium. 4. Institute of Legal Medicine, Department of Forensic Toxicology, University Hospital Frankfurt, Goethe-University , Frankfurt, Frankfurt/Main , Germany. 5. Department of Nephrology, Grand Hôpital de Charleroi , Gilly , Belgium. 6. Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain , Brussels , Belgium. 7. Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin , Turin , Italy. 8. Clinical Chemistry Department, Cliniques Universitaires Saint-Luc , Brussels , Belgium. 9. Centre for Toxicology and Applied Pharmacology, Université Catholique de Louvain , Brussels , Belgium.
Abstract
Background: Management of resistant hypertension (RHTN) is challenging and often implies the use of complex polypharmacy and interventional therapies. The main objectives of this study were (i) to describe the characteristics of patients with RHTN referred to two expert centres; (ii) to identify predictors of blood pressure (BP) control after intensive management. Methods: We reviewed electronic medical files of all patients referred for RHTN to the Brussels and Torino centres, and extracted detailed clinical data, informations on drug adherence and psychological profile. All patients with confirmed diagnosis of RHTN, according to office and ambulatory BP monitoring (ABPM) measurements, were considered eligible. Results: 313 patients (51% men; age: 56 ± 12 years; office BP 177/98 mmHg; 24-hour ABPM 153/90 mmHg) were included. At the end of follow-up (median: 2 years [1-4]), only 26% of patients (n = 81) reached BP control. When compared to patients remaining resistant, patients eventually controlled had lower pulse pressure (71 vs. 82 mmHg, p < 0.001), less often myocardial infarction (6% vs. 20%, p < 0.005) and showed a higher recourse to cognitive reappraisal as far as emotion regulation is concerned (4.8 ± 1.1 vs. 3.9 ± 1.2, p = 0.009; ERQ Questionnaire). In a multivariate analysis looking for predictors of controlled BP, only the psychological characteristic of cognitive reappraisal (i.e., changing one's thoughts about a potentially emotion-eliciting event) remained significant (OR 2.06 [1.10; 3.84], p = 0.02). Conclusions: Even in expert centres, only a minority of patients with RHTN reached BP control, irrespective of the centre involved or the interventions applied. Patients who eventually responded to therapy had lower arterial stiffness and less cardiac organ damage. Furthermore, besides vascular damage, the single predictor of BP control was the ability to modify the emotional impact of stressful situations.
Background: Management of resistant hypertension (RHTN) is challenging and often implies the use of complex polypharmacy and interventional therapies. The main objectives of this study were (i) to describe the characteristics of patients with RHTN referred to two expert centres; (ii) to identify predictors of blood pressure (BP) control after intensive management. Methods: We reviewed electronic medical files of all patients referred for RHTN to the Brussels and Torino centres, and extracted detailed clinical data, informations on drug adherence and psychological profile. All patients with confirmed diagnosis of RHTN, according to office and ambulatory BP monitoring (ABPM) measurements, were considered eligible. Results: 313 patients (51% men; age: 56 ± 12 years; office BP 177/98 mmHg; 24-hour ABPM 153/90 mmHg) were included. At the end of follow-up (median: 2 years [1-4]), only 26% of patients (n = 81) reached BP control. When compared to patients remaining resistant, patients eventually controlled had lower pulse pressure (71 vs. 82 mmHg, p < 0.001), less often myocardial infarction (6% vs. 20%, p < 0.005) and showed a higher recourse to cognitive reappraisal as far as emotion regulation is concerned (4.8 ± 1.1 vs. 3.9 ± 1.2, p = 0.009; ERQ Questionnaire). In a multivariate analysis looking for predictors of controlled BP, only the psychological characteristic of cognitive reappraisal (i.e., changing one's thoughts about a potentially emotion-eliciting event) remained significant (OR 2.06 [1.10; 3.84], p = 0.02). Conclusions: Even in expert centres, only a minority of patients with RHTN reached BP control, irrespective of the centre involved or the interventions applied. Patients who eventually responded to therapy had lower arterial stiffness and less cardiac organ damage. Furthermore, besides vascular damage, the single predictor of BP control was the ability to modify the emotional impact of stressful situations.
Entities:
Keywords:
Resistant hypertension; arterial stiffness; drug adherence; expression of emotions; polypharmacy; psychological profile; target organ damage
Authors: Saskia E van Grondelle; Sytske van Bruggen; Judith Meijer; Erik van Duin; Michiel L Bots; Guy Rutten; Hedwig M M Vos; Mattijs E Numans; Rimke C Vos Journal: BMJ Open Date: 2022-07-08 Impact factor: 3.006
Authors: João Marcos de Menezes Zanatta; Luciana Neves Cosenso-Martin; Valquíria da Silva Lopes; Jéssica Rodrigues Roma Uyemura; Aleandra Marton Polegati Santos; Manoel Ildefonso Paz Landim; Juan Carlos Yugar-Toledo; José Fernando Vilela-Martin Journal: Integr Blood Press Control Date: 2021-02-11