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Treatment Resistant Hypertension.

Brent M Egan1

  • 11. Care Coordination Institute; Greenville, S.C.

Ethnicity & Disease
|December 18, 2015
PubMed
Summary
This summary is machine-generated.

Treatment resistant hypertension (TRH) is often not true resistance, but apparent TRH due to measurement errors or poor adherence. Addressing these factors can improve blood pressure control in most patients.

Keywords:
Apparent Treatment-Resistant HypertensionHypertension

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Area of Science:

  • Cardiology
  • Nephrology
  • Pharmacology

Background:

  • Treatment resistant hypertension (TRH) affects a significant portion of hypertensive patients.
  • Apparent TRH (aTRH) is common, particularly in Black individuals, and is often due to non-adherence or measurement issues.
  • Distinguishing true TRH from aTRH is crucial for effective management.

Purpose of the Study:

  • To define treatment resistant hypertension (TRH) and apparent TRH (aTRH).
  • To explore the prevalence and causes of aTRH.
  • To outline strategies for identifying and managing aTRH.

Main Methods:

  • Review of existing literature and clinical guidelines on TRH and aTRH.
  • Analysis of factors contributing to pseudo-resistance, including measurement artifacts, suboptimal therapy, and adherence.
  • Discussion of diagnostic approaches like home and ambulatory blood pressure monitoring.
  • Guidance on optimizing antihypertensive regimens, including diuretic intensification and aldosterone antagonists.

Main Results:

  • Approximately 30% of uncontrolled and 10% of controlled hypertensive patients exhibit aTRH.
  • BP measurement artifacts, suboptimal regimens, or poor adherence account for pseudo-resistance in over 50% of aTRH cases.
  • Automated office BP averaging and out-of-office monitoring can reduce 'office' TRH.
  • Optimal therapy involves at least three different antihypertensive classes at substantial doses, with diuretics playing a key role.

Conclusions:

  • Many cases of apparent TRH can be identified and corrected through careful evaluation of measurement techniques, adherence, and medication regimens.
  • Optimizing diuretic therapy, considering aldosterone antagonists, is effective for volume-expanded TRH patients.
  • Addressing adherence, costs, and side effects improves control. Evaluation for secondary hypertension and interfering substances is recommended.
  • These interventions can resolve or identify the issue in approximately 80% of aTRH patients, with specialist referral for refractory cases.