Related Experiment Video
Updated: Aug 6, 2026
08:35
Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion
Published on: May 26, 2022
Resistant hypertension: diagnosis and management
Dimitris P Papadopoulos1, Vasilios Papademetriou
1Hypertension and Cardiovascular Research Clinic, Georgetown University/VAMC 151-E, 50 Irving Street NW, Washington, DC 20422, USA. papavip@aol.com
Journal of Cardiovascular Pharmacology and Therapeutics
|August 8, 2006
Summary
Resistant hypertension, uncontrolled blood pressure despite three medications, affects less than 5% of patients. Early evaluation and optimized drug sequencing are crucial for managing this serious condition.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Resistant hypertension is defined as blood pressure remaining above 140/90 mm Hg despite optimal doses of three antihypertensive medications, including a diuretic.
- This condition affects less than 5% of the hypertensive population but significantly elevates the risk of stroke, myocardial infarction, heart failure, and renal failure.
Purpose of the Study:
- To review the definitions and causes of resistant hypertension.
- To provide specific recommendations for the evaluation and management of patients with resistant hypertension.
Main Methods:
- Evaluation should include 24-hour ambulatory blood pressure monitoring or home blood pressure measurements.
- A focused search for secondary causes of hypertension is recommended.
- Treatment optimization involves a logical sequencing of medications based on comorbidities and patient tolerability.
Main Results:
- Long-acting, once-daily medications with good tolerability are preferred.
- Recommended drug sequence includes a diuretic, beta-blocker, angiotensin-converting enzyme/angiotensin receptor-blocker inhibitors, and a calcium-channel blocker.
Conclusions:
- Resistant hypertension is a serious condition requiring thorough evaluation and strategic management.
- Optimizing the antihypertensive drug regimen with appropriate sequencing is key to controlling blood pressure and mitigating risks.
Related Concept Videos
01:23Hypertension V: Nursing Management
The nursing management of hypertension involves accurately assessing symptoms, making a comprehensive nursing diagnosis, collaborating with patients to set goals, and implementing targeted interventions to mitigate the condition's impact and improve patient well-being.Comprehensive AssessmentThe initial step in nursing care for hypertension involves a thorough patient assessment. It includes evaluating symptoms such as headaches, dizziness, blurred vision, and previous hypertension episodes.
01:28Hypertension I: Introduction
Hypertension is a widespread, long-term medical condition where blood pressure in the arteries remains elevated. It is characterized by systolic blood pressure readings of 130 mm Hg or above or diastolic blood pressure (DBP) readings of 80 mm Hg or higher. Unmanaged hypertension poses significant health risks, making the distinction between primary (or essential) hypertension and secondary hypertension crucial, as their management and implications vary.Primary HypertensionPrimary hypertension,...
01:30Hypertension III: Clinical Manifestations and Diagnostic Studies
Hypertension is asymptomatic and also referred to as the "silent killer" until it progresses to a severe stage or causes target organ disease. Patients may experience symptoms stemming from the strain on blood vessels and tissues in various organs or the heart's increased workload.Physical exams might show no abnormalities other than high blood pressure. Signs of vascular damage, when present, correspond to the organs supplied by the affected vessels, leading to target organ damage. For...
01:28Hypertension IV: Drug Therapy and Lifestyle Modifications
Multiple classes of antihypertensive medications are employed in treating hypertension. The most commonly recommended first-line treatments include:Thiazide Diuretics, such as chlorthalidone, increase sodium and water excretion from the body, reducing blood volume and blood pressure.Angiotensin-converting enzyme inhibitors, like lisinopril, block the conversion of angiotensin I to II, a potent vasoconstrictor lowering blood pressure.Angiotensin II Receptor Blockers (ARBs) prevent angiotensin II...
01:29Hypertension II: Pathophysiology
Hypertension is a chronic condition in which the blood's force against artery walls is excessively high, posing risks such as heart disease. The condition's underlying mechanisms involve complex interactions among the cardiovascular, kidney, and autonomic nervous systems.Renin-Angiotensin-Aldosterone System (RAAS): This system significantly influences blood pressure regulation. When blood pressure decreases, the kidneys secrete renin. This enzyme transforms angiotensinogen, a plasma protein,...
01:18Hypertension and Regulation of Blood Pressure
Hypertension, the most common cardiovascular disease, is diagnosed through repeated measurements of elevated blood pressure. Its risks, including damage to the kidney, heart, and brain, are directly proportional to blood pressure levels. Starting from 115/75 mm Hg, the risk of cardiovascular disease doubles with each increment of 20/10 mm Hg. The diagnosis relies on blood pressure measurements, not on patient symptoms, as hypertension is often asymptomatic until end-organ damage is imminent or...