PSUN115 Features of Metabolic and Hemodynamic Parameters in Obese Patients with True and Pseudo-Resistant Hypertension
Authors: Shalimova Anna 
Published: November 2022

Abstract

Given the negative contribution of obesity-associated metabolic disorders to the formation of cardiovascular complications, adequate blood pressure (BP) control is very important in patients with arterial hypertension (AH) and obesity comorbidity.

Objective
to conduct a comparative assessment between metabolic and hemodynamic parametersinobese patients with true and pseudo-resistant AH.

Methods
The study included 302 patients with uncontrolled AH and obesity. Initial treatment efficacy was assessed 3 months after dual therapy was administered. Those patients who did not reach target BP in dual therapy were transferred to triple therapy. Among patients who received triple therapy, 69 people did not reach target BP (they received the fourth drug spironolactone). All patients were additionally examined 6 months after the initiation of antihypertensive therapy.

Results
A comparative assessment of BP levels was carried out between non-resistant and resistant patients: at the initial stage of enrolling patients, there was no significant difference in BP between non-resistant and subsequently resistant patients; after 3 months of follow-up (after prescribing double fixed combinations), there was a significant difference in the indicators of both office and out-of-office BP in resistance and non-resistance; despite the achievement of target BP levels after 6 months of therapy, in the presence of resistance, both office, home and most ABPM indicators were significantly higher than in non-resistance.
An assessment of the possible causes of pseudo-resistance showed that most often, pseudo-resistance was observed in patients with non-compliance with recommendations to increase physical activity (55.26%) and reduce the calorie intake of food consumed (44.77%), as well as with poor compliance to the prescribed therapy (42.11%). At the same time, high salt intake, chronic kidney disease, obstructive sleep apnoea, and the white-coat phenomenon also contributed to the formation of pseudo-resistance. More than half of the patients (63.16%) had a combination of several factors that could contribute to the formation of pseudo-resistance.
If at the stage of enrolling patients into the study and 3 months after the start of therapy there was no significant difference in BP levels between true and pseudo-resistant patients, then after 6 months of antihypertensive therapy, patients with true resistance had significantly higher levels of office SBP (p&lt;0.01) and 24 h average SBP according to ABPM data (p&lt;0.05) compared with pseudo-resistant patients. Obese patients with true resistance had also significantly lower BMI and LDL-cholesterol (p&lt;0.05) as well as higher levels of aldosterone and SBP (p&lt;0.05) compared with pseudo-resistance.

Conclusions
Even when target BP levels in antihypertensive therapy are achieved, obese resistant patients are characterized by higher levels of office and out-of-office BP, compared with non-resistance. Compared with pseudo-resistance, the presence of true resistance in obesity is associated with higher SBP and aldosteron levels, as well as lower BMI and LDL-cholesterol.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.