Development of Diagnostic and Treatment Strategy for Resistant Hypertension

Study Overview
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Brief Summary
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This study is a registry study to examine the clinical features, blood pressure control rate, and clinical prognosis of resistant hypertension in Koreans. This study will register patients with resistance hypertension in eight tertiary hospitals in Korea and follow up them for three years. The prognosis will be analysed according to etiologies, achieved blood pressure, and types of antihypertensive medication.

Detailed Description
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This study will enroll hypertensive patients who are in treatment or those who are referred from primary clinic based on inclusion or exclusion criteria. Basic clinical information, compliance with antihypertensive medications, concomitant use of other medications will be investigated and all patients will perform 24-hr ambulatory blood pressure measurement. Screening for renal artery stenosis and primary aldosteronism will be conducted. Office blood pressure will be taken every 3-6 months. Home blood pressure measurement and 24-hr ambulatory blood pressure measurement will be performed every year. The primary outcome is the newly developed MACE during the follow-up period. The secondary outcomes are newly developed target organ damage (LVH confirmed by echocardiography or EKG, carotid femoral PWV≥ 12m/s, microalbuminuria (Urine albumin-creatinine ratio ≥30 mg/g)) and decline of renal function (doubling of serum creatinine, dialysis). The follow-up period is 3 years.

Official Title
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Development of Diagnostic and Treatment Strategy for Resistant Hypertension

Conditions
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Resistant Hypertension

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 20 years and older Office SBP>130 mmHg or office DBP >90 mmHg with 3 antihypertensive medications of different classes Treated hypertensive patients with 4 antihypertensive medications of difference classes including diuretics Exclusion Criteria: desired life time under 6 months due to non-cardiovascular disease (e.g. cancer, sepsis) women with pregnancy or on nursing within the first three months after transplantation acute renal allograft rejection within six months after discharge from hospitalization for acute coronary syndrome (myocardial infarction, unstable angina) or acute stroke systolic heart failure (LVEF ≤40%)

Ages Eligible for Study
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Minimum Age: 20 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Major adverse cardiac events | Composite of cardiovascular death, myocardial infarction, stroke, admission for heart fails | 3 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Progression of CKD | Start dialysis or doubling of serum creatinine | 3 years | 
| Target organ damages | Target organ damage: LVH confirmed by echocardiography or EKG; carotid femoral PWV≥ 12m/s; microalbuminuria (Urine albumin-creatinine ratio ≥30 mg/g) | 3 years | 
| Target blood pressure achievement | Target blood pressure: Achievement of BP below 130/80 or 140/90 mmHg | 3 years |