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Resistant hypertension-defining the scope of the problem
Richard Chia1, Ambarish Pandey2, Wanpen Vongpatanasin1
1Hypertension Section, University of Texas Southwestern Medical Center, Dallas, TX; Cardiology Division, University of Texas Southwestern Medical Center, Dallas, TX.
Progress in Cardiovascular Diseases
|December 22, 2019
Summary
The American Heart Association updated resistant hypertension (RH) definition to uncontrolled blood pressure (BP) despite 3 medications. Screening for pseudo-resistance, like white coat hypertension, is crucial for effective patient management.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Practice Guidelines
Background:
- Resistant hypertension (RH) is defined by the American Heart Association as uncontrolled blood pressure (BP) despite 3 anti-hypertensive drug classes.
- The updated BP criteria indicate a modest increase in RH prevalence (3-4%) in the US treated population.
Purpose of the Study:
- To highlight the updated definition of resistant hypertension (RH).
- To emphasize the importance of screening for pseudo-resistance in apparent RH cases.
Main Methods:
- Review of the American Heart Association's updated scientific statement on resistant hypertension.
- Meta-analysis of observational studies examining the prevalence of true RH versus pseudo-RH.
Main Results:
- The updated definition of RH involves uncontrolled BP (≥130/80 mmHg) despite a regimen including a calcium channel blocker, renin-angiotensin system blocker, and thiazide diuretic.
- Pseudo-resistant hypertension, stemming from white coat hypertension or medication nonadherence, is as prevalent as true RH.
- A 3-4% increase in RH prevalence is observed in the treated US population under new criteria.
Conclusions:
- Screening for pseudo-resistance is vital in evaluating patients with apparent RH.
- Identifying white coat hypertension avoids unnecessary treatment, while addressing medication nonadherence improves BP control.
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