Prevalence and characteristics of pseudohypertension in patients with “resistant hypertension”

Pseudohypertension has been described as a cause of resistant hypertension, due to medial hypertrophy of the artery from atherosclerosis. This phenomenon results in an elevated cuff pressure compared with intra-arterial measurements and is found primarily in populations with advanced age and atherosclerotic disease. The purpose of this review was to investigate the clinical picture and medical outcomes of patients with this phenomenon. We conducted a retrospective chart review between April 2009 and October 2011 of 244 patients seen in our Hypertension clinic. Baseline characteristics and outcomes of pharmacologic and lifestyle modifications were analyzed. There were 17/244 (7%) patients found to have pseudohypertension among patients enrolled. The mean number of antihypertensive medications decreased from 3.7 to 2.7, following a mean of 4.1 visits. All patients had a brachial artery bruit and triphasic blood pressure readings via Doppler. Our findings suggest that elderly patients with concomitant history of atherosclerotic disease, renal insufficiency, and diabetes mellitus have the highest risk of developing pseudohypertension. This condition should be considered in patients with resistant hypertension. Blood pressure measurement with Doppler can be considered as a noninvasive investigation. Recognition of this entity may result in potential cost reduction with fewer medications prescribed.