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Cardiovascular outcome in treated hypertensive patients with responder, masked, false resistant, and true resistant hypertension

Pieromenico SD, Lapenna D, Bucci A, et al.

Summary

The aim of this study was to evaluate the cardiovascular outcome in apparently responder hypertensive patients with responder and masked hypertension, and in apparently resistant hypertensive patients with false and true hypertension. The occurrence of fatal and nonfatal cardiovascular events was evaluated in patients with responder hypertension, with masked hypertension, with false resistant hypertension, and with true resistant hypertension. During a follow-up period, cardiovascular risk was significantly higher in masked hypertension and in true resistant hypertension, whereas there was no significant difference between false resistance and responder hypertension. To conclude, this study shows that patients with masked hypertension are at higher risk than those with responder hypertension, and that those with resistant hypertension are at lower risk than those with true resistant hypertension.

Am J Hypertens. 2005;18:1422-1428.

Commentary

The technique of ambulatory blood pressure measurement (ABPM) has prompted certain authors to classify subgroups of hypertensive patients by means of criteria such as responder, masked, false resistant, and true resistant hypertension, respectively. The authors of the present paper studied the cardiovascular outcome and events in these categories of patients for a period of five years. The risk profiles of these subgroups of patients appeared to differ with respect to cardiovascular and cerebrovascular events. The results can be summarized as follows:

Patients with masked hypertension are at a higher risk than those with false resistant hypertension.
Patients with false resistant hypertension are at a lower risk than those with true resistant hypertension.

The authors support ABPM in all treated hypertensives, in order to obtain a more precise prognostic stratification.