The Algorithm for the Treatment of Patients With Treatment-Resistant Hypertension at the Outpatient Stage

Abstract

Every year in the world, arterial hypertension is the cause of death in about 9 million cases. Blood pressure control in patients has not yet reached the appropriate level, and the percentage of resistant arterial hypertension remains high. According to the definition of the American Heart Association, those patients whose condition requires taking four or more drugs to control blood pressure should be considered resistant to treatment. It should be understood that uncontrolled hypertension is not synonymous with RAH. The presence of RAH significantly increases the risk of cardiovascular complications, contributes to serious damage to target organs. Preliminary diagnosis of RAH definitely requires the exclusion of secondary hypertension, which is a rather heterogeneous group of diseases that is poorly recognized.
 The goal of the work. To acquaint general practice - family medicine doctors with the algorithm of treatment of patients with resistant arterial hypertension at the ambulatory stage.
 Treatment of patients with RAH should be carried out in stages, with increased therapy, using the most simplified scheme of taking drugs. Today, the combination of ACEI (perindopril), BCC (amlodipine) and diuretic (indapamide) is considered as the most optimal triple combination of antihypertensive drugs. Medicines containing three antihypertensive drugs in one tablet are offered precisely for RAH patients.
 Conclusions. The implementation of the algorithm for the examination of patients with RAH, recommendations for changing their lifestyle and a step-by-step therapy plan allow improving the control of blood pressure. Treatment of patients with RAH should include optimization of dosages and the appointment of rational combinations of antihypertensive drugs in order to enhance synergistic effects. Optimization of pharmacotherapy by prescribing drugs with fixed combinations can improve control of drug administration. The fixed combination of amlodipine-indapamide-perindopril may have the important advantage of increasing treatment adherence due to the principle of "one pill per day".