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Resistant hypertension: concepts and approach to management
Gary E Sander1, Thomas D Giles
1Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA 70005, USA.
Current Hypertension Reports
|September 17, 2011
Summary
Resistant hypertension (RH) affects many, but careful assessment can reveal white coat effects or adherence issues in up to 30% of cases. True RH requires targeted treatments addressing underlying mechanisms like aldosterone signaling and sympathetic activity.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Resistant hypertension (RH) is defined as blood pressure (BP) requiring four or more antihypertensive agents.
- RH is prevalent in elderly patients, potentially affecting 20% of the hypertensive population.
- Pseudoresistance due to improper BP measurement, non-adherence, or interfering medications must be excluded.
Purpose of the Study:
- To review the definition, prevalence, and diagnostic challenges of resistant hypertension.
- To explore the underlying pathophysiologic mechanisms driving true RH.
- To outline current and emerging therapeutic strategies for managing RH.
Main Methods:
- Literature review of studies on resistant hypertension diagnosis and management.
- Analysis of pathophysiologic mechanisms including aldosterone signaling, sympathetic overactivity, and fluid retention.
- Evaluation of pharmacologic and device-based therapeutic interventions.
Main Results:
- Approximately 30% of patients evaluated for RH exhibit white coat hypertension or pseudoresistance.
- Key mechanisms of true RH include aldosterone abnormalities, sodium retention, sympathetic nervous system overactivity, and obstructive sleep apnea.
- Standard treatment involves renin-angiotensin-aldosterone system inhibitors, calcium channel blockers, and diuretics, with aldosterone blockers as a fourth agent.
Conclusions:
- Accurate diagnosis of RH requires excluding pseudoresistance and white coat effects through careful monitoring.
- Targeted treatment based on specific patient profiles and underlying mechanisms is crucial for effective RH management.
- Novel device therapies targeting sympathetic denervation show promise for future RH treatment.
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