Determinants of formation of true resistance to antihypertensive treatment in patients with arterial hypertension with concomitant obesity

The aim of the research: identify combinations of genetic and neurohumoral factors that influence the development of true resistance to antihypertensive therapy (AHT) in patients with concomitant obesity (OB). Materials and Methods. The study included 200 patients aged 45–55 with uncontrolled hypertension and obesity. Treatment was prescribed in accordance with the European Guidelines 2018. Thiazide-like diuretics were additionally prescribed to those patients who did not reach the target blood pressure (BP) level after 3 months of dual therapy. Resistant hypertension was diagnosed in 48 patients who had an uncontrolled course of hypertension at the optimal doses of three antihypertensive drugs during the next month of their reception, while true resistance was found in 21 patients. The effectiveness of comprehensive treatment was evaluated after 6 months. Results. The application of the logistic regression method at the stage of initial examination of patients showed that the early predictors of the formation of truly resistant hypertension in obese patients are CIMT, HOMA index and genetic polymorphism IRS-1. After treatment, the model of truly resistant hypertension in patients with obesity included indicators that influenced its formation at the pre-treatment stage, as well as the new ones: adiponectin, waist circumference and genetic polymorphism ADIPOQ. Conclusions. Genetic markers, insulin resistance, and vascular wall status play a leading role in the development of true resistance to AHT in obese patients. It is established that the main determinants of the formation of true resistance to AHT in patients with this comorbidity are IRS-1 polymorphism, HOMA index and CIMT.