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Refractory versus resistant hypertension: Novel distinctive phenotypes.
Tanja Dudenbostel1, Mohammed Siddiqui1, Nitin Gharpure1
1Vascular Biology and Hypertension Program, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Journal of Nature and Science
|October 17, 2017
Summary
Resistant hypertension (RHTN) is common, but refractory hypertension may stem from neurogenic causes, not just fluid retention. Treatment for refractory cases may require sympathetic inhibition rather than intensified diuretic therapy.
Area of Science:
- Cardiology
- Nephrology
- Hypertension Research
Background:
- Resistant hypertension (RHTN) affects 10-20% of treated hypertensive patients, defined as BP >140/90 mmHg despite ≥3 medications including a diuretic.
- Refractory hypertension is a severe phenotype characterized by BP >140/90 mmHg despite ≥5 medications, including a diuretic and MRA.
Purpose of the Study:
- To review and compare resistant hypertension (RHTN) and refractory hypertension.
- To explore definitions, prevalence, mechanisms, characteristics, comorbidities, and cardiovascular risk of these conditions.
Main Methods:
- Literature review focusing on current knowledge regarding RHTN and refractory hypertension.
- Comparative analysis of proposed definitions and etiological mechanisms.
Main Results:
- Excess fluid retention is a common mechanism for RHTN.
- Emerging evidence suggests refractory hypertension may be neurogenic, driven by increased sympathetic activity.
- Standard RHTN treatment intensification with diuretics and MRAs may not be effective for refractory hypertension.
Conclusions:
- Refractory hypertension presents a distinct clinical challenge compared to RHTN.
- Effective management of refractory hypertension may necessitate strategies targeting sympathetic overactivity, potentially including device-based approaches.