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Predictors of resistant hypertension in an unselected sample of an adult male population in Italy

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Abstract

Prevalence, incidence and predictors of resistant hypertension (RH), (defined as blood pressure persistently above goal in spite of the concurrent use of three antihypertensive agents of different classes) in the general population remain largely unknown. A complete database including anthropometric and biochemical data was collected in 1994–1995 (baseline examination) in 1,019 participants (mean age 51.8, range: 25–79 years) and again in 2002–2004 in 794 male participants of the Olivetti Heart Study (OHS) in southern Italy. The incidence of RH over the average follow-up time of 7.9 years was 4.8% (38/794) in the whole study population and 10.1% (31/307) among hypertensive participants. Basal blood pressure (systolic, diastolic or pulse pressure), cholesterol and urinary albumin/creatinine ratio (ACR) significantly predicted the risk of developing RH using a logistic regression model that also included age as covariates. If in the same model we added basal pharmacological treatment, the fractional excretion of sodium (FENa) also became a statistically significant predictor, and this last model explained nearly 25% of the risk of developing RH. In this unselected sample of an adult male population, ACR (an early marker of organ damage), an elevated FENa (a proxy for dietary sodium intake), cholesterol and a higher basal blood pressure level were independent predictors of RH.

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Conflict of interest

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Author information

Authors and Affiliations

  1. Department of Clinical and Experimental Medicine, “Federico II” University of Naples Medical School, Via S. Pansini, 5, 80131, Naples, Italy

    Antonio Barbato, Ferruccio Galletti, Roberto Iacone, Giovanni Rossi, Renato Ippolito, Antonella Venezia & Pasquale Strazzullo

  2. Clinical Sciences Research Institute, Warwick Medical School, Coventry, UK

    Francesco P. Cappuccio

  3. Department of Preventive Medical Sciences, Federico II University Medical School, Naples, Italy

    Eduardo Farinaro

Authors
  1. Antonio Barbato
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  2. Ferruccio Galletti
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  3. Roberto Iacone
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  4. Francesco P. Cappuccio
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  5. Giovanni Rossi
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  6. Renato Ippolito
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  7. Antonella Venezia
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  8. Eduardo Farinaro
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  9. Pasquale Strazzullo
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Corresponding author

Correspondence to Pasquale Strazzullo.

Additional information

On behalf of The Olivetti Heart Study Research Group: P. Strazzullo (coordinator), G. Barba, F.P. Cappuccio, E. Farinaro, F. Galletti, A. Siani.

Appendices

Appendix 1

Differences in selected variables between participants who were or were not lost to the follow-up

Follow-up (2002–2004 examination)

Lost (n = 143)

Re-visited (n = 794)

p

Age (years)*

53.2 (28.5–79.4)

51.4 (25.6–74.0)

0.085

BMI (kg/m2)

27.1 (18.8–34.9)

26.8 (19.0–37.0)

0.417

Waist circumference (cm)

94.9 (70.0–125.0)

94.3 (42.0–122.0)

0.393

Systolic BP (mmHg)*

133.2 (89.0–225.0)

128.7 (90.0–185.0)

0.010

Diastolic BP (mmHg)*

84.3 (44.0–130.0)

83.7 (58.0–115.0)

0.452

Serum creatinine (mg/dL)*

1.06 (0.82–3.59)

1.05 (0.48–4.43)

0.775

Serum cholesterol (mg/dL)

220.6 (111.0–344.0)

221.6 (66.0–385.0)

0.795

Serum trygliceride (mg/dL)

151.0 (42.0–498.0)

152.6 (21–978)

0.847

Serum uric acid (mg/dL)

5.64 (2.10–9.70)

5.71 (1.60–9.70)

0.533

Fractional excretion of Na+ (%)*

1.25 (0.31–3.47)

1.22 (0.04–8.18)

0.548

Cornell product (mm × ms)§

1,293.2 (376.0–3,477.0)

1,315.7 (67.0–3,913.2)

0.842

Hypertension (%)

50

38.7

0.010

Diabetes (%)

5.5

6.7

0.583

Abnormal ACR (%)

11.5

6.4

0.029

  1. Mean (range); p from ANOVA for normal distributed variables and from *Mann–Whitney U for not normal distributed variables; § n = 732

Appendix 2

Changes in anti-hypertensive drug consumption over 8 years among participants with resistant hypertension at the 2002–2004 visit

Appendix 3

Binary logistic regression analysis using resistant hypertension (yes/no) at follow-up as dependent variable and baseline age, pulse pressure, BMI, FENa, serum cholesterol, triglyceride, uric acid, ACR (yes/no) and antiHPT Rx (yes/no) as covariates (n = 794)

Variables entered

Variables

Odds ratio

95% confidence interval

p

Adjusted R square

Hosmer–Lemeshow test

Lower bound

Upper bound

p

Age

0.773

0.508

1.177

0.230

0.251

0.717

BMI

1.207

0.840

1.736

0.310

Pulse pressure

2.087

1.467

2.969

<0.001

Serum cholesterol

1.532

1.055

2.222

0.025

Serum glucose

0.863

0.563

1.322

0.497

Serum triglyceride

1.083

0.801

1.464

0.604

Serum uric acid

1.061

0.734

1.534

0.753

FENa

1.281

1.018

1.611

0.035

Abnormal ACR* (yes/no)

2.812

1.089

7.263

0.033

AntiHPT Rx (yes/no)

5.558

2.478

12.463

<0.001

  1. To allow a comparative evaluation of the effects of the different factors on the risk to develop RH
  2. Z scores were calculated for each variable (except for AntiHPT Rx and albumin/creatinine ratio *(>30 mg/g))

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Barbato, A., Galletti, F., Iacone, R. et al. Predictors of resistant hypertension in an unselected sample of an adult male population in Italy. Intern Emerg Med 7, 343–351 (2012). https://doi.org/10.1007/s11739-011-0554-2

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