True prevalence of resistant hypertension

Hypertension; Prevalence; Medication Adherence

LETTER TO THE EDITOR

True prevalence of resistant hypertension

Andréa Rodrigues Sabbatini^I; Vanessa Fontana^I; Heitor Moreno Jr^II

^ICardiovascular Pharmacology Laboratory, Departmentof Pharmacology, Faculty of Medical Sciences, State University of Campinas, SP – Brazil

^IIResistant Hypertension Unit, Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas, SP – Brazil

Mailing Address

Keywords: Hypertension; Prevalence; Medication Adherence.

Dear Editor,

The true prevalence of resistant hypertension (RHT) is unknown, at least in part because its definition is not consistent worldwide. We have read with great interest the article by Massierer et al. ⁽¹⁾ showing that the frequency of patients with true RHT is lower (3.0-4.5% of the general hypertensive population) in clinical settings when compared to 14.5% estimated in the Spanish ABPM Registry ⁽²⁾. In our opinion, the latter estimates do not completely account for uncontrolled hypertension secondary to undertreatment and poor adherence, for example. Thus, the present findings are probably much closer to the real prevalence of RHT considering that errors due to inconsistencies in defining RHT, lack of strict criteria for inclusion of patients and absence of quality control of the data were correctly taken into account.

Reply

We appreciate your interest in our work¹. To establish the real frequency of diseases is essential for the planning of care and resource allocation. Sometimes the estimates are artificially increased due to selection biases. This appears to be the present issue on the prevalence of resistant hypertension. I agree with the colleagues regarding the understanding that this prevalence is overestimated. Variable definitions and case selection in unrepresentative samples contribute to that, but it is worth noting that many patients have this condition because of insufficient treatment adherence. In pragmatic terms, patients with high blood pressure because they are not using blood pressure drugs are at similar risk to those who use the medication and show inadequate response. Regarding the former, we should employ all the techniques and efforts to convince them to take the medication; as for the latter, which have a less frequently observed condition, advanced diagnostic and therapeutic methods should be used to treat them.

Sincerely,

Flávio Danni Fuchs, Daniela Massierer, Ana Claudia Tonelli de Oliveira, Ana Maria Steinhorst, Miguel Gus, Aline Maria Ascoli, Sandro Cadaval Gonçalves, Leila Beltrami Moreira, Vicente Correia Jr, Gerson Nunes, Sandra Costa Fuchs

References

Referência (Carta-resposta)

• 1. Massierer D, Oliveira AC, Steinhorst AM, Gus M, Ascoli AM, Goncalves SC, et al. Prevalence of resistant hypertension in non-elderly adults: prospective study in a clinical setting. Arq Bras Cardiol. 2012;99(1):630-5.
• 2. de la Sierra A, Banegas JR, Oliveras A, Gorostidi M, Segura J, de la Cruz JJ, et al. Clinical differences between resistant hypertensives and patients treated and controlled with three or less drugs. J Hypertens. 2012;30(6):1211-6.
• 1. Massierer D, Oliveira AC, Steinhorst AM, Gus M, Ascoli AM, Goncalves SC, et al. Prevalence of resistant hypertension in non-elderly adults: prospective study in a clinical setting. Arq Bras Cardiol. 2012;99(1):630-5.

Publication Dates

• Publication in this collection
  22 Nov 2012
• Date of issue
  Nov 2012

History

• Received
  24 July 2012
• Accepted
  23 Aug 2012
• Reviewed
  24 July 2012