Treatment-resistant hypertension: A focus on prevalence of nonadherence, associated factors and renal sympathetic denervation

Hameed, Mohammed A (2020). Treatment-resistant hypertension: A focus on prevalence of nonadherence, associated factors and renal sympathetic denervation. University of Birmingham. Ph.D.

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Hypertension is a leading cause of cardiovascular and cerebrovascular morbidity and mortality worldwide. Treatment-resistant hypertension represents a cohort of patients with treated hypertension with at least 3 antihypertensives. In this thesis the important role of adherence testing, and prevalence of non-adherence is described to establish a diagnosis of true treatment-resistant hypertension. A review of renal sympathetic denervation has identified the development and shortcomings of this technique and research studies to date which has been further adapted for use by using carbon dioxide angiography in a pilot study of patients with chronic kidney disease to eliminate the risk of contrast-induced nephropathy associated with the commonly used iodinated contrast agents. A study was designed and conducted to describe the phenotypical and biochemical characteristics of patients with true treatment-resistant hypertension and to assess fluid and tissue body composition, arterial stiffness, endothelial dysfunction, inflammation and presence of obstructive sleep apnoea in these patients. The results have shown that patients with true treatment-resistant hypertension have a metabolic-syndrome-like phenotype with a high risk of future cardiovascular events, evidence of hyperaldosteronism, higher endothelial dysfunction and inflammation but similar levels of arterial stiffness when compared to non-treatment-resistant hypertension patients.

Type of Work: Thesis (Doctorates > Ph.D.)
Award Type: Doctorates > Ph.D.
Licence: All rights reserved
College/Faculty: Colleges (2008 onwards) > College of Medical & Dental Sciences
School or Department: Institute of Applied Health Research
Funders: None/not applicable
Subjects: R Medicine > RC Internal medicine
R Medicine > RZ Other systems of medicine


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