Resistant Hypertension

Abstract

The most common causes of therapeutic failure in hypertensive control are undiscovered secondary causes of hypertension and lack of patient/doctor compliance. In about 10% of cases, it can be attributed to resistant hypertension caused by a hyperactivity of the sympathetic nervous system, condition with a high cardiovascular risk to the patient. Resistant hypertension is failure to diminish blood pressure values to <140/90 mmHg (<140/85 mmHg for diabetic patients) with a lifestyle method and prescription of least three antihypertensive drugs in optimal doses, including a diuretic, or when patients use four or more antihypertensive drugs regardless of blood pressure control. Patients with resistant hypertension are typically presented with a long-standing history of poorly controlled hypertension. Early diagnosis and adequate treatment are needed to avoid end organ damage and to prevent cardiorenovascular remodeling. Cardiorenovascular morbidity and mortality are significantly higher in resistant hypertensive population. 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. New innovative device therapies create an additional novel pathway of blood pressure-lowering procedures and should be prescribed by a specialist hypertension clinic.

The pion: an enigma within the Standard Model

“…This perspective is canvassed elsewhere [150] and can be used to argue that the potential between infinitely-heavy quarks measured in numerical simulations of quenched lQCD -the so-called static potential [178] -is disconnected from the question of confinement in our Universe. This is because light-particle creation and annihilation effects are essentially nonperturbative in QCD, so it is impossible in principle to compute a quantum mechanical potential between two light quarks [179][180][181]. It follows that there is no flux tube in a Universe with light quarks and consequently that the flux tube is not the correct paradigm for confinement.…”

“…The potential energy accumulated within the tube may increase only until it reaches that required to produce a particle-antiparticle pair of the theory's pseudo-Nambu-Goldstone modes. Simulations of lQCD show [179,180] that the flux tube then disappears instantaneously along its entire length, leaving two isolated colour-singlet systems. The length-scale associated with this effect in QCD is r σ ≃ (1/3) fm and hence if any such string forms, it would dissolve well within a hadron's interior.…”

Emergent phenomena and partonic structure in hadrons

“…It can be used to argue that: the so-called "vacuum condensates" are actually wholly contained within hadrons [17][18][19][20]; and the potential between infinitely-heavy quarks measured in numerical simulations of quenched lQCD -the so-called static potential [21] -is disconnected from the question of confinement in our Universe. The latter follows because light-particle creation and annihilation effects are essentially nonperturbative in QCD, so it is impossible in principle to compute a quantum mechanical potential between two light quarks [22][23][24]. It follows that the flux tube measured in numerical simulations of lQCD with static quarks has no relevance to confinement in the light-quark realm of QCD.…”

Nucleon Viewed as a Borromean Bound-State

“…The potential energy accumulated within the tube may increase only until it reaches that required to produce a particle-antiparticle pair of the theory's pseudo-Goldstone modes. Simulations of lattice-regularised QCD (lQCD) show [7,8] that the flux-tube then disappears instantaneously along its entire length, leaving two isolated color-singlet systems. The length-scale associated with this effect in QCD is around 1/3 fm and hence if any such string forms, it would dissolve well within hadron interiors.…”