Background: Aorto-femoral pulse wave velocity (PWV) has been shown to be modifiable by antihypertensive treatment in newly diagnosed hypertension (HT), but little is known about the effect of treatment on longer standing, refractary HT.

Methods: Longitudinal study that included 79 (49 men, 62 %) patients with refractary hypertension, treated with at least three drugs in standard dosis. We measured at the initial visit standard clinical variables, as well as PWV (Sphygmocor-System), ECG-left ventricular mass (CORNELL-product and SOKOLOW) and microalbuminuria to asses target organ damage. At a median of 1,15 (SD±0,34) years, a second visit was performed, measures were repeated.

Results: The mean age was 64±11 years with initial systolic and diastolic BP of 155/79 mmHg (SD±25/11). The initial prevalence of left ventricular hypertrophy (LVH), pathological urinary albumin excretion rate (UAER) and PWV > 12 m/sec were 42, 16 and 27 %, respectively. Considering a decrease of 1 m/seg as a significant change in PWV, 36 % of patients showed an improvement in PWV. In a logistic multivariate regression analysis, systolic BP reduction > 9 mmHg (OR: 4,1, p<0,01), initial PWV (OR: 1,5, p<0,009) and glucemic control (HbA1c > 6,5 %, OR: - 0,2, p<0,049) were independently associated with a decrease of PWV.

Conclusions: In hypertensive patients with refractory HT, BP treatment is able to decrease PWV, correcting for age, gender and initial PWV-values, whereas a poor glucemic control appears to hinder the positive effect of antihypertensive treatment.