Epidemiology, prognosis, and treatment of resistant hypertension

Resistant hypertension is a common clinical problem, which, until recently, has received little attention in the medical literature. With this increased attention has come a considerably better understanding of disease epidemiology, prognosis, and treatment, yet much remains unknown. Current data suggest that the prevalence of resistant hypertension has been increasing in recent decades, a concerning finding given that resistant hypertension appears to be associated with a poorer prognosis than nonresistant hypertension. The most appropriate management for these patients has not been fully elucidated, but a multifaceted approach incorporating accurate diagnosis, identification, and removal of substances that interfere with blood pressure, dietary and lifestyle management, and treatment with rational drug combination therapy can be quite effective in controlling blood pressure in these patients. Newer therapies, both pharmacologic and interventional procedures, are under study and may hold promise in the future treatment of resistant hypertension. This review highlights recent research on disease epidemiology and prognosis, and it describes the current body of literature on the treatment of this increasingly common condition.