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Resistant Hypertension: Mechanisms and Treatment
Andrew Y Hwang1,2, Eric Dietrich1,3, Carl J Pepine4
1Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, PO Box 100486, Gainesville, FL, 32610-0486, USA.
Current Hypertension Reports
|June 10, 2017
Summary
Treatment-resistant hypertension (TRH) involves multiple factors like fluid retention and hormonal imbalances. Management strategies include optimizing diuretics and adding aldosterone antagonists, with further approaches tailored to individual mechanisms.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Treatment-resistant hypertension (TRH) presents a significant clinical challenge.
- Multiple underlying mechanisms contribute to the development of TRH.
Purpose of the Study:
- To review recent findings on the mechanisms driving TRH.
- To discuss current pharmacotherapeutic strategies for managing TRH.
Main Methods:
- Literature review of emerging evidence on TRH pathophysiology.
- Analysis of current pharmacotherapeutic options for TRH.
Main Results:
- Key mechanisms include sodium/fluid retention, renin-angiotensin-aldosterone system activation, and sympathetic nervous system activity.
- Arterial stiffness and gut dysbiosis are emerging potential contributors.
- Diuretic optimization and aldosterone antagonists are recommended as foundational therapies.
- Tailoring treatment to specific mechanisms and patient factors is advised.
Conclusions:
- TRH pathophysiology is complex, involving multiple interconnected mechanisms.
- Targeting these mechanisms offers potential for improved blood pressure control.
- Further research is needed to validate targeted approaches against standard care.
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