Refractory hypertension (RfHTN) is a phenotype of antihypertensive treatment failure defined as uncontrolled BP despite the use of effective doses of ≥5 antihypertensive medications including a long-acting thiazide-like diuretic (chlorthalidone) and a mineralocorticoid receptor antagonist. The degree of medication nonadherence is unknown among patients with RfHTN. In this prospective evaluation, 54 patients with apparent RfHTN were recruited from the University of Alabama at Birmingham Hypertension Clinic after having uncontrolled BP at 3 or more clinic visits. All patients’ BP was evaluated by automated office BP and 24-hour ambulatory BP monitoring (n=49). Antihypertensive medication adherence was determined by measuring 24-hour urine specimens for antihypertensive medications and their metabolites by high-performance liquid chromatography-tandem mass spectrometry (n=45). Of the 45 patients who completed 24-hour ambulatory BP monitoring, 40 (88.9%) had confirmed RfHTN based on an elevated automated office BP (≥130/80 mm Hg), mean 24-hour ABP (≥125/75 mm Hg), and mean awake (day-time) ABP (≥130/80 mm Hg). Out of the 40 fully evaluated patients with RfHTN, 16 (40.0%) were fully adherent with all prescribed medications. Eighteen (45.0%) patients were partially adherent and 6 (15.0%) had none of the prescribed agents detected in their urine. Of 18 patients who were partially adherent, 5 (12.5%) were adherent with at least 5 medications, including chlorthalidone and the mineralocorticoid receptor antagonist, consistent with true RfHTN. Of patients identified as having apparent RfHTN, 52.5% were adherent with at least 5 antihypertensive medications, including chlorthalidone and a mineralocorticoid receptor antagonist, confirming true RfTHN. These findings validate RfHTN as a rare, but true phenotype of antihypertensive treatment failure.

中文翻译：

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抗高血压药物依从性和真性难治性高血压的确认

难治性高血压 (RfHTN) 是一种抗高血压治疗失败的表型，定义为尽管使用了有效剂量≥5 种抗高血压药物，包括长效噻嗪样利尿剂（氯噻酮）和盐皮质激素受体拮抗剂，但仍无法控制血压。RfHTN 患者的药物不依从性程度未知。在这项前瞻性评估中，来自阿拉巴马大学伯明翰高血压诊所的 54 名明显 RfHTN 患者在 3 次或更多次就诊时血压未得到控制后被招募。所有患者的血压均通过自动诊室血压和 24 小时动态血压监测（n=49）进行评估。通过高效液相色谱-串联质谱法（n=45）测量 24 小时尿液样本中的抗高血压药物及其代谢物来确定抗高血压药物的依从性。在完成 24 小时动态血压监测的 45 名患者中，40 名（88.9%）根据升高的自动诊室血压（≥130/80 mm Hg）、平均 24 小时 ABP（≥125/75 mm Hg）确诊 RfHTN和平均清醒（白天）ABP（≥130/80 mm Hg）。在 40 名经过全面评估的 RfHTN 患者中，16 名（40.0%）完全依从所有处方药。18 名 (45.0%) 患者部分依从，6 名 (15.0%) 患者的尿液中未检测到任何处方药物。在部分依从性的 18 名患者中，5 名 (12.5%) 依从至少 5 种药物，包括氯噻酮和盐皮质激素受体拮抗剂，与真正的 RfHTN 一致。在被确定为明显 RfHTN 的患者中，52.5% 的患者坚持使用至少 5 种抗高血压药物，包括氯噻酮和盐皮质激素受体拮抗剂，证实了真正的 RfTHN。这些发现证实 RfHTN 是一种罕见但真实的抗高血压治疗失败表型。