Resistant hypertension

Capsule Commentary on Fontil, et al. Physician Underutilization of Effective Medications for Resistant Hypertension at Office Visits in the United States: NAMCS 2006-2010

“…It is not clear whether it will be sufficient to swiftly improve the care of patients with resistant hypertension. Indeed, the clinical inertia of physicians not specialized in hypertension (an inertia due to several factors including misguided acceptance of elevated blood pressure and underestimation of cardiovascular disease risk) 5 might remain a meaningful barrier to changing treatment of resistant hypertension even after the implementation of a treatment algorithm.…”

Renal Sympathetic Denervation Therapy for Treatment of Resistant Hypertension

“…The National Institute for Health and Clinical Excellence guideline suggests that the 3 drugs should be an angiotensin-converting enzyme inhibitor or angiotensin blocker plus a calcium channel blocker plus a thiazide-type diuretic [5].…”

“…Before a patient is considered to have resistant hypertension, pseudo-resistant hypertension and white coat-resistant hypertension must be excluded [5,6]. Poor patient compliance, inadequate doses of antihypertensive drugs, inadequate choice of combinations of antihypertensive drugs, poor office blood pressure measurement technique, and having to pay for costs of drugs are factors associated with resistant hypertension [1,7].…”

“…Factors contributing to resistant hypertension include obesity, excess dietary sodium, excess alcohol intake, use of cocaine, amphetamines, non-steroidal anti-inflammatory drugs, contraceptive hormones, adrenal steroid hormones, sympathomimetic drugs (nasal decongestants and diet pills), erythropoietin, licorice, herbal supplements such as ephedra, progressive renal insufficiency, and inadequate diuretic therapy [5]. Secondary causes of resistant hypertension include primary hyperaldosteronism, renal artery stenosis, renal parenchymal disease, obstructive sleep apnea, coarctation of the aorta, Cushing's syndrome, pheochromocytoma, hyperthyroidism, hypothyroidism, and intracranial tumors [5,8].…”

“…Secondary causes of resistant hypertension include primary hyperaldosteronism, renal artery stenosis, renal parenchymal disease, obstructive sleep apnea, coarctation of the aorta, Cushing's syndrome, pheochromocytoma, hyperthyroidism, hypothyroidism, and intracranial tumors [5,8].…”