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Resistant hypertension: challenges in everyday practice
Katarzyna Stolarz-Skrzypek1, Danuta Czarnecka2
1First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland. katarzyna.stolarz-skrzypek@uj.edu.pl
Polish Archives of Internal Medicine
|December 13, 2023
Summary
Resistant hypertension, defined as uncontrolled blood pressure despite optimal medication, affects older patients with comorbidities. Management involves assessing adherence, excluding secondary causes, and considering advanced therapies like spironolactone or device-based treatments.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Resistant hypertension is defined as blood pressure (BP) remaining above 140/90 mm Hg despite using three antihypertensive drugs, including a diuretic, at maximum doses.
- Patients with resistant hypertension are typically older and have more comorbidities than the general hypertensive population.
- Confirmation of uncontrolled hypertension requires out-of-office BP measurements, preferably 24-hour ambulatory BP monitoring.
Purpose of the Study:
- To outline the definition and diagnostic considerations for resistant hypertension.
- To emphasize the importance of optimizing pharmacotherapy and excluding contributing factors.
- To discuss advanced treatment strategies for resistant hypertension.
Main Methods:
- Reviewing the definition of resistant hypertension based on BP thresholds and medication regimens.
- Highlighting the necessity of confirming uncontrolled BP with ambulatory monitoring.
- Emphasizing the exclusion of secondary hypertension and medication nonadherence.
- Discussing the role of mineralocorticoid receptor antagonists and device-based therapies.
Main Results:
- Resistant hypertension is characterized by older age and higher comorbidity burden.
- Pseudoresistance can stem from nonadherence to medication or lifestyle recommendations.
- Optimal pharmacotherapy assessment and exclusion of drug interactions are crucial.
- Mineralocorticoid receptor antagonists (e.g., spironolactone) are recommended for expanding therapy beyond three drugs.
- Device-based treatments are an option for select patients.
Conclusions:
- Accurate diagnosis of resistant hypertension requires careful assessment of medication adherence, lifestyle factors, and exclusion of secondary causes.
- Optimizing existing therapy and considering mineralocorticoid receptor antagonists are key management steps.
- Device-based therapies offer an additional option for selected patients with resistant hypertension.
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