[Epidemiology and etiology of therapy-resistant hypertension]

Uncontrolled arterial hypertension is a frequent clinical problem, affecting 1/10 of hypertensive subjects, and can lead to severe renal, cerebral and cardiovascular damage. Common causes of poorly controlled blood pressure include lack of compliance, inadequate antihypertensive medication and white-coat hypertension, all referred to as "false" therapy-resistant hypertension. 4-19% of patients with arterial hypertension suffer from "true" therapy-resistant hypertension: this is defined as failure to achieve target blood pressure values despite full-dose triple drug regimen including a diuretic. In most cases, its etiology is multifactorial. Frequent causes include interfering medication, volume overload, chronic kidney disease, obstructive sleep apnea and secondary causes such as primary aldosteronism. Factors such as obesity, high salt intake and excessive alcohol ingestion contribute to poor blood pressure control. This article reviews the literature and describes epidemiology and etiology of therapy-resistant hypertension.