Drug-Resistant Hypertension Associations with Gastrointestinal and Endocrine Disorders and Implications for Evaluation and Management.

Abstract

Background: Drug-resistant hypertension (DRH) is used to refer to high blood pressure that cannot be controlled by taking at least 3 antihypertensive drugs, including a diuretic. DRH is most of the time related to the secondary causes, such as gastrointestinal and endocrine disorders, which can complicate the treatment process and predispose to cardiovascular make-up.

Objectives: The Study aimed assessing the correlation between DRH and gastrointestinal and endocrine disorders, investigating the effect of these diseases on blood pressure regulation, and the effectiveness of specific interventions in the management of DRH.

Methodology: this study conducted at Department of Medicine, LRH-MTI, Peshawar between jan 2019 and Jan 2020.120 patients who were diagnosed with DRH were undertaken in a retrospective cohort study. In-depth assessments of secondary etiologies comprised laboratory assessments of aldosterone, renin, cortisol, catecholamine’s, thyroid, and renal functions. Demographics of patients, comorbidities and treatment were gathered. Statistical calculations were done in SPSS which included descriptive statistics, Chi-square tests, and regression analysis. Systolic pressure less than 140mmHg was considered to be blood pressure control and diastolic pressure less than 90 mmHg was also thought of as blood pressure control.

Results: The Mean age = 80 years, SD ≈ 1.58 years.58 % of the respondents were women. The most common secondary causes were primary hyperaldosteronism (32%), pheochromocytoma (15%), Cushing’s syndrome (12%) and chronic kidney disease (21%). Baseline mean of SBP and DBP were 160/15mmHg and 100/12mmHg. Only after specific management, 70% of the patients were able to control blood pressure (p = 0.02). This was especially effective in tumor resection in pheochromocytoma and in the mineralocorticoid receptor antagonists of hyperaldosteronism.

Conclusion: DRH is highly caused by gastrointestinal and endocrine disorder. The secondary causes can be identified and treated earlier which enhances blood pressure control, but multifactorial interventions might be needed in complex cases. Multidisciplinary approach is also necessary in managing DRH and comprehensively.