[Treatment options for resistant hypertension: from pseudoresistant to refractory hypertension]

Resistant hypertension is defined as blood pressure above the target level despite treatment with 3 classes of antihypertensive drugs, including a diuretic. A large number of patients meeting the definition of TRH actually have 'pseudoresistant hypertension': there is either a secondary cause of the hypertension, non-adherence, high dietary salt intake, or use of interfering co-medication or recreational drugs. Treating pseudoresistant hypertension is just as challenging as 'true' resistant hypertension since causes of resistance cannot always be eliminated and elimination of causes will not necessarily lead to blood pressure normalization. It is estimated that only 10% of patients with TRH have 'true' resistant hypertension. A very small proportion of these patients is defined as having 'refractory hypertension' because their blood pressure still remains uncontrolled despite extending their medication to five or more agents, including an aldosterone receptor blocker. At present, non-pharmacological, invasive interventions should be considered only in patients with refractory hypertension.