Resistant hypertension in patients with type 2 diabetes: Clinical correlates and association with complications

Anna Solini, Giacomo Zoppini, Emanuela Orsi, Cecilia Fondelli, Roberto Trevisan, Monica Vedovato, Franco Cavalot, Olga Lamacchia, Maura Arosio, Marco G. Baroni, Giuseppe Penno, Giuseppe Pugliese

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: The phenotype of resistant hypertension in patients with type 2 diabetes has been poorly characterized. This cross-sectional analysis of the large cohort from the Renal Insufficiency and Cardiovascular Events (RIACE) study was aimed at assessing the clinical correlates and association with complications of resistant hypertension in patients with type 2 diabetes. Methods: The RIACE study enrolled 15 773 patients consecutively visiting 19 diabetes clinics during the years 2007-2008. Resistant hypertension, defined as BP values not on target (i.e. >130/80 mmHg, respectively) with three antihypertensive agents, was detected in 2363 individuals (15% of the whole RIACE cohort, 17.4% of hypertensive individuals, and 21.2% of treated hypertensive patients). Patients without resistant hypertension [nonresistant hypertension (NRH)], that is on target with one (n = 1569), two (n = 1369), and three (n = 803) drugs, and individuals with uncontrolled hypertension, that is untreated or not on target with less than three drugs (n = 7440), served as controls. Results: As compared with NRH and uncontrolled hypertension patients, patients with resistant hypertension were older and more frequently women and had significantly higher waist circumference, albuminuria, and serum creatinine, and lower glomerular filtration rate. Prevalence values of chronic kidney disease and advanced retinopathy were significantly higher in resistant hypertension than in both nonresistant hypertension and uncontrolled hypertension individuals, whereas cardiovascular disease was more frequent in resistant hypertension versus uncontrolled hypertension, but not nonresistant hypertension patients, especially those on 2-3 drugs. Conclusions: Resistant hypertension is relatively common in patients with type 2 diabetes. In these individuals, age, female sex and waist circumference are independent correlates of resistant hypertension, which is strongly associated with microvascular (especially renal) disease, whereas relation with macrovascular complications is unclear.

Original languageEnglish
Pages (from-to)2401-2410
Number of pages10
JournalJournal of Hypertension
Volume32
Issue number12
DOIs
Publication statusPublished - 2014

Keywords

  • Cardiovascular disease
  • Chronic kidney disease
  • Diabetic retinopathy
  • Resistant hypertension
  • Type 2 diabetes

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine

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