Identifying patients with resistant hypertension and options for clinical management

In addition to the increasing prevalence of hypertension, the number of patients with treatment-resistant hypertension is also rising. It is important to identify these patients in order to improve the treatment outcomes and to screen for potential secondary causes. Clinical characteristics of patients with resistant hypertension include advanced age, male gender, obesity, high salt intake and alcohol consumption. Those with high baseline blood pressure, diabetes, chronic kidney disease or obstructive sleep apnea are also prone to developing resistant hypertension. Physicians should initiate close monitoring and aggressive treatment for those patients, as resistant hypertension is associated with a higher risk of cardiovascular morbidities, regardless of the control of blood pressure. However, treatment of resistant hypertension is currently a great challenge in clinical practice as all of these patients are already taking multiple antihypertensive medications, including the first-line treatments advocated in guidelines. In patients who have been presented multiple drugs, the room for further titration is often limited. Spironolactone has been demonstrated to be effective as an add-on therapy for patients with resistant hypertension. In addition to drug treatment, baroreceptor stimulation therapy and renal sympathetic denervation are promising new approaches in this group of patients. Further studies on the pathogenesis and the treatment of resistant hypertension would help to improve the outcome of this patient subgroup.