Evaluation of muscle/fat ratio in patients with resistant systemic hypertension

Introduction: This study aims to investigate the effects of body composition parameters (such as muscle/fat ratio, basal metabolic rate (BMR), body mass index (BMI)) on blood pressure regulation in patients with resistant hypertension (HT). Resistant HT is defined by uncontrolled blood pressure despite multiple antihypertensive treatments and poses a significant risk for cardiovascular complications. Methods: Ninety-two patients with persistent hypertension who had systolic blood pressure (SBP) ≥140 mmHg and/or diastolic blood pressure (DBP) ≥90 mmHg despite at least three antihypertensive drugs were included in the study. Anthropometric measurements (BMI, muscle/fat ratio, BMR), blood pressure, laboratory parameters and echocardiographic findings of the patients were evaluated at baseline and after two months. Regression analyses were used to determine independent predictors of changes in SBP, DBP and mean blood pressure (MBP). Results: At the end of the 2-month follow-up, significant decreases were observed in SBP, DBP and MBP (p<0.001). In parallel, a significant decrease in BMI and fat mass, and an increase in BMR and muscle/fat ratio were found (p<0.05). In the regression analysis, the independent determinants of change in SBP were determined as decrease in BMI, increase in BMR and improvement in muscle/fat ratio (p=0.012, p=0.005 and p<0.001, respectively). Increase in BMR, decrease in E/E' ratio and increase in muscle/fat ratio had significant effects on change in DBP (p=0.047, p=0.036 and p<0.001, respectively). Change in MBP showed a strong correlation with decrease in BMI and increase in BMR and muscle/fat ratio (p=0.023, p=0.043 and p<0.001, respectively). Conclusion: This study demonstrates that improvements in body composition, particularly muscle/fat ratio and basal metabolic rate, play a critical role in blood pressure control in patients with resistant hypertension. Decreases in BMI and fat mass contribute significantly to blood pressure regulation. It is concluded that lifestyle changes aimed at increasing muscle/fat ratio to healthy levels may be an effective strategy in the management of resistant hypertension and in improving overall cardiovascular health. These findings need to be confirmed in larger populations and long-term studies. Key words: Resistant Hypertension, Body Composition, Muscle/Fat Ratio, Basal Metabolic Rate, Blood Pressure Regulation, Lifestyle Changes