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Resistant hypertension: challenges in everyday practice.

Katarzyna Stolarz-Skrzypek1, Danuta Czarnecka2

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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.

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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.