Resistant hypertension: a review of diagnosis and management.

@article{Vongpatanasin2014ResistantHA,
  title={Resistant hypertension: a review of diagnosis and management.},
  author={Wanpen Vongpatanasin},
  journal={JAMA},
  year={2014},
  volume={311 21},
  pages={
          2216-24
        }
}
Resistant hypertension-uncontrolled hypertension with 3 or more antihypertensive agents-is increasingly common in clinical practice. Clinicians should exclude pseudoresistant hypertension, which results from nonadherence to medications or from elevated blood pressure related to the white coat syndrome. In patients with truly resistant hypertension, thiazide diuretics, particularly chlorthalidone, should be considered as one of the initial agents. The other 2 agents should include calcium… 

Figures and Tables from this paper

Approaches for the Management of Resistant Hypertension in 2020

  • W. Aronow
  • Medicine
    Current Hypertension Reports
  • 2020
Clinical trials are indicated for the treatment of resistant hypertension by sacubitril/valsartan and also by firibastat and a mineralocorticoid receptor antagonist should be added to the therapeutic regimen.

Resistant Hypertension: Newer ManagementApproaches

Various device therapies like chronic electrical stimulation of the carotid sinus and Catheter-based renal sympathetic denervation have been tried in the management of resistant hypertension though the success is still eluding.

Resistant Hypertension

The need for the individualization of therapy and the use of the management strategies are also given weight in the treatment of resistant hypertension patients, including optional, innovative therapies, like a renal denervation or baroreflex activation.

Drug Therapy of Apparent Treatment-Resistant Hypertension: Focus on Mineralocorticoid Receptor Antagonists

A number of studies summarized here show that an MR antagonist is effective in reducing BP when added to the standard multi-drug regimen.

Resistant Hypertension and Cardiorenovascular Risk

In this review, the most current approaches to resistant hypertension and cardiovascular risk based on the available literature evidence will be discussed.

Device-Based Therapy for Drug-Resistant Hypertension: An Update

Device-based therapy for drug-resistant hypertension has the potential to provide alternative treatment options to certain groups of patients who are refractory or intolerant to current antihypertensive medications, but more research is needed to prove its efficacy.

[Resistant hypertension : What is it?].

When blood pressure is poorly controlled despite treatment with a diuretic and two antihypertensive drugs at adequate doses, the hypertension is termed resistant. The prevalence of resistant

Secondary Hypertension: Discovering the Underlying Cause.

Primary hypertension should be considered in the presence of suggestive symptoms and signs, such as severe or resistant hypertension, age of onset younger than 30 years (especially before puberty), malignant or accelerated hypertension, and an acute rise in blood pressure from previously stable readings.

Time to recognize continuous positive airway pressure as a blood pressure-lowering treatment in patients with obstructive sleep apnoea and resistant hypertension?

I ncreasing prevalence of arterial hypertension (AH), the main cause of disability and premature death worldwide, represents a major public health concern. This is especially true for the subgroup of
...

References

SHOWING 1-10 OF 98 REFERENCES

Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research.

Expanding the understanding of the causes of resistant hypertension and thereby potentially allowing for more effective prevention and/or treatment will be essential to improve the long-term clinical management of this disorder.

Incidence and Prognosis of Resistant Hypertension in Hypertensive Patients

Patients with resistant hypertension had an increased risk of cardiovascular events, which supports the need for greater efforts toward improving hypertension outcomes in this population.

Resistant Hypertension: Comparing Hemodynamic Management to Specialist Care

Measurements of thoracic fluid volume support occult volume expansion as a mediator of antihypertensive drug resistance and use of impedance measurements to guide advancing diuretic dose and adjustment of multidrug anti Hypertensive treatment.

Low dose spironolactone reduces blood pressure in patients with resistant hypertension and type 2 diabetes mellitus: a double blind randomized clinical trial

Low dose spironolactone exerts significant BP and urinary albumin creatinine ratio lowering effects in high-risk patients with resistant hypertension and type 2 diabetes mellitus.

Comparing Hemodynamic Management to Specialist Care

Measurements of thoracic fluid volume support occult volume expansion as a mediator of antihypertensive drug resistance and use of impedance measurements to guide advancing diuretic dose and adjustment of multidrug anti Hypertensive treatment.

Resistant hypertension: a frequent and ominous finding among hypertensive patients with atherothrombosis.

The presence of resistant hypertension identifies a subgroup of patients with hypertension and atherothrombosis who are at heightened risk for adverse long-term outcomes.

Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients.

The benazepril-amlodipine combination was superior in reducing cardiovascular events in patients with hypertension who were at high risk for such events.

Management of resistant arterial hypertension: role of spironolactone versus double blockade of the renin–angiotensin–aldosterone system

SPR at daily doses of 25–50 mg shows a potent antihypertensive effect when added to prior regimes of single RAAS axis blockade in patients with resistant arterial hypertension.

The Association Between Medication Adherence and Treatment Intensification With Blood Pressure Control in Resistant Hypertension

In this cohort of patients with resistant hypertension, treatment intensification but not medication adherence was significantly associated with 1-year BP control, highlighting the need to investigate why patients with uncontrolled BP do not receive treatment intensifying.

Obstructive Sleep Apnea: The Most Common Secondary Cause of Hypertension Associated With Resistant Hypertension

Age >50 years, large neck circumference measurement, and snoring are good predictors of obstructive sleep apnea in this population, and obstructiveSleep apnea appears to be the most common condition associated with resistant hypertension.
...