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Revisiting resistant hypertension: a comprehensive review.
Ryan J Chan1, Wryan Helmeczi2, Swapnil S Hiremath1,3
1Division of Nephrology, Department of Medicine, University of Ottawa and the Ottawa Hospital, Ottawa, Ontario, Canada.
Internal Medicine Journal
|July 26, 2023
Summary
Resistant hypertension (RHT) is high blood pressure despite medication. Careful diagnosis and management are crucial for better cardiovascular outcomes.
Area of Science:
- Cardiology
- Nephrology
- Internal Medicine
Background:
- Resistant hypertension (RHT) affects 10-30% of hypertensive patients.
- RHT is defined as blood pressure above targets despite three medications, including a diuretic.
- Risk factors include diabetes, obesity, and lifestyle; RHT increases cardiovascular risk.
Purpose of the Study:
- To review RHT definitions, diagnosis, and management.
- To discuss newer agents and research needs for RHT.
Main Methods:
- Literature review of RHT definitions and management strategies.
- Discussion of diagnostic challenges, including pseudoresistance and secondary hypertension.
- Exploration of pharmacologic and non-pharmacologic treatment options.
Main Results:
- Accurate diagnosis of RHT is essential, excluding pseudoresistance and secondary causes.
- Optimizing non-pharmacologic management and adherence is critical.
- Fourth-line agents and device therapies are considered after initial management.
Conclusions:
- Careful diagnosis and management of RHT are vital for reducing cardiovascular risk.
- Further research is needed on newer agents and advanced interventions for RHT.
- Optimizing treatment strategies can improve outcomes for patients with resistant hypertension.
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