Protocolo de screening para determinação de prevalência da hipertensão arterial resistente aparente, hipertensão arterial resistente verdadeira e pseudorresistente

Abstract

Resistant Hypertension (RHTN) is defined as a persistence of blood pressure (BP) above the recommended targets ≥ 140 / 90mmHg with the use of three or more antihypertensive drugs, one of them being diureti or using four or more drugs even with controlled BP. However, the prevalence of RHTN has been overestimated due to the occurrence of pseudoresistant arterial hypertension (pRHTN) associated with factors such as inadequate BP measurement, effect of the white coat, inadequate pharmacotherapy and non-adherence. The present study aimed to determine by means of a screening protocol the apparent resistant hypertension, Resistant hypertension (RHTN) and Pseudoresistant Hypertension (pRHTN) through clinical screening in primary and specialized care services. A cross - sectional study was carried out with patients attending primary and specialized care in Maceió - Brazil, Patients with a diagnosis of hypertension on antihypertensive treatment were included in the study. Data collection took place at the time of dispensing the medication and had the application of socio-demographic forms and therapeutic adherence, values of systolic blood pressure (SBP) and diastolic blood pressure (DBP) by means of two BP measurements with an interval of 10 minutes and Monitoring Ambulatory Blood Pressure (MABP) in the exclusion of white lab coat syndrome.Then it was analyzed therapeutic adherence was then analyzed using the Morisky-Green-Levine scale of adherence and antihypertensive regimen by the Medication Appropriateness Index (MAI). A database was prepared in Epi info 6.04 and analyzes were performed in SPS for Windows Version 13.0 and Stata 13.1, descriptive statistical analyzes (mean, median, minimum, maximum, dispersion and scale of loss, as well as Pearson's Chi-square, T test for independent samples and ANOVA. The significance level adopted was p<0.05. A total of 439 patients included in this study, 54.4% did not present controlled BP, the non-compliance rate was 70.2% and the IRT was 66,7%. The prevalence rates for aRHTN, true RHTN and pRHTN were 14.3%, 3.0% and 11.3% respectively. Among the cases of pRHTN, 9.7% were caused by poor adherence to the treatment. Patients with aRHTN had 14.1 mmHg of SBP (p = 0.00) and 5.2 mmHg of DBP (p = 0.00) more than those with AMBULATORIAL systemic arterial hypertension (SAH), evidencing the importance of identifying the factors pseudoresistence since the beginning of treatment. The design of this protocol allowed the identification of different subgroups of patients, allowing the occurrence of specific RHTN and pRHTN prevalence, which culminated in lower prevalences than those found regularly in the literature