[Therapy-resistant and therapy-refractory arterial hypertension]

Area of Science:

• Cardiology
• Hypertension Research
• Clinical Therapeutics

Background:

• Arterial hypertension presents challenges in management, with distinct forms of therapy resistance.
• Therapy-resistant and therapy-refractory hypertension necessitate structured diagnostic and therapeutic approaches.
• Excluding pseudoresistance and secondary hypertension is a critical initial step.

Purpose of the Study:

• To delineate the differences between therapy-resistant and therapy-refractory arterial hypertension.
• To outline a structured approach for managing these distinct hypertensive conditions.
• To review available therapeutic options, including pharmacological and interventional strategies.

Main Methods:

• Comparative analysis of prevalence, pathogenesis, and prognosis.
• Systematic review of treatment guidelines and clinical evidence.
• Evaluation of diagnostic criteria for pseudoresistance and secondary hypertension.

Main Results:

• Therapy-resistant hypertension shows better response to intensified diuretic therapy.
• Therapy-refractory hypertension is often managed with sympathoinhibitory therapy.
• Interventional procedures are considered when medical therapies are exhausted.

Conclusions:

• Accurate differentiation between resistant and refractory hypertension is essential for optimal patient outcomes.
• A stepwise therapeutic algorithm, including diuretics, sympathoinhibitory agents, and interventions, guides management.
• Structured evaluation and tailored therapy are key to addressing complex arterial hypertension.