OPTIMIZATION OF DIFFERENTIAL DIAGNOSIS OF ESSENTIAL RESISTANT AND PSEUDORESISTANT ARTERIAL HYPERTENSION IN THE FAMILY DOCTOR PRACTICE

Introduction. The prevalence of resistant hypertension, according to various estimates, is from 5 to 30% of hypertensive patients. However, the true prevalence of resistant hypertension is difficult to quantify because many patients actually suffer from pseudoresistant hypertension, the main reasons of which are lack of adherence to treatment and ineffective antihypertensive therapy.

The objective. Assessment of the effectiveness of improved by us method of differential diagnosis of essential resistant and pseudoresistant hypertension in comparison with conventional methodology in the family doctor practice.

Materials and methods. 120 patients (men — 68 (56.7%), women — 52 (43.3%), the average age — (55.0±8.8) years) with essential resistant hypertension lasting more than 3 years were studied prospectively. Patients were divided into 2 groups: in group I (control) (n=60) — by conventional method; in group II (basic) (n=60) — by the technique that we have improved. In both groups at the beginning of the study and after correction of antihypertensive therapy, an evaluation of its effectiveness was carried out by measuring the office blood pressure level.

Results. It was found that the sensitivity of the method of differential diagnostics proposed by us, compared with the conventional one, was 83.3% (p>0.1), specificity — 98.2% (p>0.5). The use of our improved technique allows significantly to shorten the timing of the differential diagnosis of essential resistant and pseudoresistant hypertension, in comparison with the conventional management (p<0.01).

Conclusions. The declared method, in comparison with the conventional one, allows to reduce the time of differential diagnostics of essential resistant and pseudoresistant hypertension considerably and faster to achieve a significant reduction in systolic blood pressure (>10 % of the initial level) in this category of patients.