Adverse cardiac remodeling is absent in patients with true controlled resistant hypertension

Faris Matanes, Mohammed Siddiqui, Alejandro Velasco, Oleg Sharifov, Eric Kreps, Tanja Dudenbostel, Eric K. Judd, Bin Zhang, Steven G. Lloyd, Suzanne Oparil, David A. Calhoun

Research output: Contribution to journalArticlepeer-review


Resistant hypertension (RHTN), defined as blood pressure (BP) that is uncontrolled with ≥3 medications, including a long-acting thiazide diuretic, also includes a subset with BP that is controlled with ≥4 medications, so-called controlled RHTN. This resistance is attributed to intravascular volume excess. Patients with RHTN overall have a higher prevalence of left ventricular hypertrophy (LVH) and diastolic dysfunction compared to patients with non-RHTN. We tested the hypothesis that patients with controlled RHTN due to the intravascular volume excess have higher left ventricular mass index (LVMI), higher prevalence of LVH, larger intracardiac volumes, and more diastolic dysfunction compared to patients with controlled non-resistant hypertension (CHTN), defined as BP controlled with ≤3 anti-hypertensive medications. Patients with controlled RHTN (n = 69) or CHTN (n = 63) who were treated at the University of Alabama at Birmingham were offered enrollment and underwent cardiac magnetic resonance imaging. Diastolic function was assessed by peak filling rate, time needed in diastole to recover 80% of stroke volume, E:A ratios and left atrial volume. LVMI was higher in patients with controlled RHTN (64.4 ± 22.5 vs 56.9 ± 11.5; P =.017). Intracardiac volumes were similar in both groups. Diastolic function parameters were not significantly different between groups. There were no significant differences in age, gender, race, body mass index, dyslipidemia between the two groups. The findings show that patients with controlled RHTN have higher LVMI, but comparable diastolic function to those of patients with CHTN.

Original languageEnglish (US)
Pages (from-to)416-425
Number of pages10
JournalJournal of Clinical Hypertension
Issue number5
StatePublished - May 2023
Externally publishedYes


  • cardiac remodeling
  • diastolic function
  • left ventricular mass
  • masked uncontrolled hypertension
  • resistant hypertension

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism


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