Assessment and management of resistant hypertension

Abstract

• Resistant hypertension is estimated to affect 10% of adults with hypertension.• Pseudoresistance and secondary hypertension must be excluded.• The optimal base regimen for most patients comprises a diuretic, an angiotensin-converting-enzyme inhibitor or angiotensin-receptor blocker, and a dihydropyridine calcium-channel blocker.• Long-acting combination products should be used to maximize adherence to treatment.• Mineralocorticoid receptor antagonists, and α-and β-blockers are the most commonly used add-on drugs. Key points Box 1: Evidence for this reviewWe searched MEDLINE (1946 through Apr. 21, 2013) using the keywords "resistant hypertension" and "refractory hypertension." We excluded duplicate articles and limited the search to human studies that were published in English. Of 1163 citations screened, we reviewed 187 full-text articles, including 8 randomized controlled trials and 2 consensus guideline statements. We also scanned reference lists to identify additional citations of relevance.

Apparent Treatment Resistant Hypertension, Blood Pressure Control and the Progression of Chronic Kidney Disease in Patients with Type 2 Diabetes

“…The prevalence of RH has been reported to vary considerably, from 10 to 40% [3,7], depending on the clinical setting and confounding factors such as poor adherence to treatment. Thus, it has been suggested that the term apparent treatment resistant hypertension (aTRH) should be used when adherence to medications or out-of-office BP cannot be verified [8].…”

The Impact of Obesity on the Pharmacology of Medications Used for Cardiovascular Risk Factor Control

“…53,54 This finding is in keeping with obesity being a known risk factor for development of hypertension and resistant hypertension through multiple pathways (including activation of the renin-angiotensin system, sympathetic nervous system activation, and development of sleep apnea, among others). [55][56][57][58] Antihypertensive drugs and cardiovascular morbidity/ mortality…”

Management of resistant hypertension

“…Amiloride was mentioned in the review by Padwal and colleagues 1 as an alternative therapy for primary aldosteronism, but it is important to recognize that it is the specific treatment for Liddle variants. 2 For that reason, it is important to diagnose Liddle variants among patients with resistant hypertension.…”