Resistant Hypertension in Clinical Practice in India: Jaipur Heart Watch.

ABSTRACT

BACKGROUND: Hypertension is highly prevalent in India but frequency of resistant hypertension has not been well studied. METHODS: We performed a registry-based study at a single center in patients with primary diagnosis of hypertension (n=3073). Details of co-morbidities, medications and blood pressure (BP) control were obtained. Patients with coronary heart disease, cerebrovascular disease and chronic kidney disease were excluded. Resistant hypertension was defined as uncontrolled hypertension (BP ≥140/90) with use of 3 drugs of which one was a diuretic, or any 4 drugs. RESULTS: Mean age of patients was 59±13 years, 47% were women and 26% <50y age. Diabetes was in 31.1%, hypothyroidism in 7.9% and chronic obstructive lung disease in 4.3%. The drugs prescribed were angiotensin converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) in 61.5%, beta blockers in 49.8%, dihydropyridine calcium channel blockers (CCB) in 46.8%, ARB in 44.4%, diuretics in 32.1% ACEi in 13.4%, other CCBs in 2.6% and mineralocorticoid receptor antagonists (MRA) in 1.1%. One antihypertensive drug was prescribed in 27.4%, two in 41.2%, three in 18.6% and four or more in 5.4%. Prevalence of resistant hypertension using standard definition was 19.4% (95% confidence interval, CI, 18.0-20.8%). It was more in women (23.5%) vs men (15.7%) (p<0.001). Using the alternate definition the prevalence was 6.3% (95% CI 5.3-7.0%) and also more in women (6.9%) vs men (5.4%). Resistant hypertension was more common in patients >60 years (odds ratio 1.36, 95% CI 1.18-1.58) and women (odds ratio 1.64, 95% CI 1.37-1.97). CONCLUSION: Prevalence of resistant hypertension is high in a secondary-care practice in India. It is significantly greater among older patients and women.