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310 CLINICAL CHARCTERISTICS OF RESISTANT HYPERTENSION EVALUATED BY AMBULATORY BLOOD PRESSURE MONITORING

Objectives: It has been shown that strict control of blood pressure is important to prevent cardiovascular disease, although it is sometimes difficult to decrease blood pressure to target blood pressure levels. The aim of the present study was to investigate the clinical characteristics of resistant hypertension using ambulatory blood pressure monitoring. Methods: One hundred in hospital patients, whose 24-hour average blood pressure was higher than 130/80 mmHg even after treatment with more than three antihypertensive drugs, were included in the present analysis. Circadian variation of blood pressure was evaluated by the nighttime decrease in systolic blood pressure (&Dgr;SBP); i.e. dipper (10%⩽&Dgr;SBP<20%), non-dipper (0%⩽&Dgr;SBP<10%), riser (&Dgr;SBP<0%), and extreme-dipper (&Dgr;SBP≥20%). An estimated glomerular filtration rate (eGFR) was calculated by using modified MDRD equation for Japanese. Results: Average blood pressures were both high in daytime and nighttime, 150.0/82.3 and 143.8/78.2 mmHg, respectively. Twenty patients had been treated with hemodialysis or peritoneal dialysis. In 63 patients out of the other 80 patients (79%), eGFR was also decreased (< 60 ml/min/1.73m2). The patients classified into dipper, non-dipper, riser and extreme-dipper were 20%, 43%, 34% and 3%, respectively. In addition, in 17 patients whose eGFR was preserved, 12 patients were non-dipper or riser, suggesting that it seemed difficult to account for this altered circadian blood pressure variation only by renal dysfunction. Conclusions: A large number of the patients with resistant hypertension suffered from renal dysfunction, although altered circadian blood pressure variation was difficult to be explained only by renal dysfunction.