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Resistant Hypertension: A Clinical Perspective
Fady Hannah-Shmouni1, Sriram Gubbi2, J David Spence3
1Internal Medicine-Endocrinology, Hypertension and Metabolic Genetics, Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 10 Center Drive, MSC 1109, Bethesda, MD 20892, USA.
Endocrinology and Metabolism Clinics of North America
|October 28, 2019
Summary
Resistant hypertension, a condition of high blood pressure unresponsive to multiple treatments, affects many patients with comorbidities. Optimizing treatment involves lifestyle changes and tailored, renin/aldosterone-based therapies to reduce cardiovascular risks.
Area of Science:
- Cardiology
- Nephrology
- Internal Medicine
Background:
- Resistant hypertension is defined as blood pressure that remains high despite three or more antihypertensive medications.
- It is frequently associated with comorbidities and is more prevalent in individuals of African descent.
- Secondary causes and medication nonadherence must be excluded for accurate diagnosis.
Purpose of the Study:
- To outline strategies for optimizing blood pressure control in patients with resistant hypertension.
- To emphasize the importance of a renin/aldosterone-based diagnostic and treatment approach.
- To highlight the role of lifestyle modifications and combination therapies in managing resistant hypertension.
Main Methods:
- Review of current clinical definitions and patient characteristics of resistant hypertension.
- Discussion of diagnostic considerations, including exclusion of secondary causes and nonadherence.
- Exploration of therapeutic strategies, including lifestyle interventions, single-pill combinations, and renin/aldosterone-targeted treatments.
Main Results:
- Resistant hypertension is linked to significant cardiovascular risk.
- A tailored approach focusing on renin/aldosterone pathways can improve treatment efficacy.
- Mineralocorticoid receptor antagonists or amiloride are favored in specific patient profiles.
Conclusions:
- Effective management of resistant hypertension requires a multi-faceted strategy.
- Personalizing therapy based on the renin/aldosterone system is crucial for better outcomes.
- Reducing cardiovascular events while minimizing side effects is the primary goal of treatment.
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