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Resistant hypertension, secondary hypertension, and hypertensive crises
1Emory University School of Medicine, 1100 Parker Place, Atlanta, GA 30324-5402, USA. whall@emory.edu
Insights
Resistant hypertension and hypertensive crises are dangerous but manageable. Early diagnosis and treatment, including ACE-inhibitor renal scintiscans and gradual blood pressure reduction, significantly lower complication risks.
Area of Science:
- Cardiology
- Nephrology
- Hypertension Management
Background:
- Resistant hypertension, secondary hypertension, and hypertensive crises are uncommon but serious conditions.
- These conditions increase the risk of myocardial infarction, heart failure, stroke, and renal failure.
Purpose of the Study:
- To outline diagnostic and management strategies for uncommon forms of hypertension.
- To reduce the risk of severe complications associated with these hypertensive conditions.
Main Methods:
- Review of diagnostic screening tests for renovascular hypertension, such as ACE-inhibitor renal scintiscan.
- Discussion of management strategies for resistant hypertension, including diuretic therapy and angioplasty.
- Classification and management principles for hypertensive crises (urgencies and emergencies).
Main Results:
- Resistant hypertension in compliant patients is often linked to obesity and inadequate diuretic therapy.
- ACE-inhibitor renal scintiscan is a key screening tool for renovascular hypertension.
- Angioplasty success varies by patient age and the cause of renovascular hypertension (fibrous dysplasia vs. atherosclerosis).
- Hypertensive crises require gradual blood pressure reduction, avoiding abrupt normalization.
Conclusions:
- Appropriate diagnostic screening and selective management can dramatically reduce complications from resistant hypertension, secondary hypertension, and hypertensive crises.
- Management should be tailored to the specific hypertensive condition, focusing on gradual blood pressure control in crises.
Abstract:
Resistant hypertension, secondary hypertension, and hypertensive crises are uncommon but potentially dangerous forms of hypertension that are associated with an increased risk of complications such as myocardial infarction, heart failure, stroke, and renal failure. Appropriate diagnostic screening and selective drug or surgical management can reduce the risk of these complications dramatically. In compliant patients, resistant hypertension occurs most often in obese patients receiving inadequate diuretic therapy. In patients with clinical clues to the diagnosis, the best current screening test for renovascular hypertension is probably the ACE-inhibitor renal scintiscan. Angioplasty is considerably more successful in younger patients with fibrous dysplasia than in older patients with the atherosclerotic variety. Hypertensive crises are divided into BP urgencies and emergencies. In both settings, the reduction in BP should generally be gradual rather than abrupt, with no intent to acutely normalize the BP.