Abstract Body (Do not enter title and authors here): Resistant hypertension, defined as blood pressure >130/80 mm Hg despite using ≥3 antihypertensive medications, is a well-recognized clinical entity. Patients with resistant hypertension are at an increased risk of cardiovascular disease including heart failure (HF) compared with those with more easily controlled hypertension. Many providers and patients alike are in desperate need of indicators that can help prevent and avoid symptomatic HF (Stage 3 AHA), or worse advanced HF (Stage 4 AHA). In early stages of HF in patients with Resistant Hypertension (RHTN) there have not been any investigations into biomarkers.
We conducted a cross-sectional analysis of patients referred to the Hypertension Clinic at the University of Alabama at Birmingham. In this study we analyzed data of patients with RHTN, and compared it with patients with hypertension (HTN). Demographics, body mass index, and blood pressure measurement were taken. Patients underwent blood samples, urine collection, and cardiac MRI assessment.
We found that RHTN patients had higher fat free mass (FFM) (139.1 ± 29.3 vs 125.5 ± 23.4lbs, p = 0.0236). RHTN patients had a higher waist to hip ratio (W/H) (0.95 ± 0.1 vs 0.9 ± 0.05, p = 0.029). RHTN patients had lower levels of potassium present in their blood (3.9 ± 0.4 vs 4.3 ± 0.48mmol/L, p<0.001). RHTN patients had higher Urinary Aldosterone (U-Aldo) (13.4μg ±10.1 vs 9.3μg ± 6.1, p = 0.01449). RHTN patients also had higher aldosterone renin ratio (14.7 ± 16.9 vs 7.2 ± 4.6, p < 0.001). RHTN patients’ BNP and ANP were higher (41 ± 74.2 vs 19.4 ± 18.2, p = 0.007) (82.4 ± 54 vs 54.6 ± 32.6, p = 0.012). Among all of the Cardiac MRI measurements the most significant were the left ventricular mass (LVM) (169.5 ± 46.25 vs 125.6 ± 29.75, p < 0.001), the LVM end diastolic (LVM ED) (162.4 ± 44.4 vs 120.8 ± 27.1, p < 0.001), the LVM end systolic (LVM ES) ( 177.3 ± 49.7 vs 130.5 ± 32.8, p < 0.001), the LVM posterior wall (LVPW) (10.3 ± 2.6 vs 8.1 ± 1.4, p< 0.001), and IVS (12.5 ± 2.5 vs 10.1± 1.4, p< 0.001). There was no difference in age, BMI, serum creatinine, urinary Sodium, and urinary potassium. When analyzed by gender or race there was no difference between groups.
In summary, aldosterone renin ratio and urinary aldosterone are potential biomarkers for patients with RHTN on a high Na diet with stage 2 HF. Underlying mechanisms including hemodynamics and endocrine dysregulation need further investigation in patients with stage 2 HF.