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Evaluation and Management of Resistant Hypertension: Core Curriculum 2024
Jennifer L Cluett1, Jeffrey H William2
1Division of General Medicine (JLC), Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Complex Hypertension Clinic (JLC, JHW), Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Summary
Resistant hypertension, uncontrolled blood pressure despite multiple medications, requires accurate measurement and adherence assessment. Effective management involves lifestyle changes, optimizing medications, and addressing secondary causes for better cardiovascular outcomes.
Area of Science:
- Cardiology
- Nephrology
- Internal Medicine
Background:
- Resistant hypertension (RH) affects patients with blood pressure above goal despite adherence to 3 first-line agents or controlled on 4+ medications.
- Accurate diagnosis of RH necessitates excluding white coat hypertension through out-of-office measurements.
- Patients with RH face elevated risks for cardiovascular events and may have secondary, treatable causes.
Purpose of the Study:
- To define resistant hypertension and outline diagnostic and management strategies.
- To emphasize the importance of accurate blood pressure measurement and adherence.
- To highlight the need for addressing secondary causes and optimizing treatment.
Main Methods:
- Defining RH based on medication adherence and blood pressure control.
- Utilizing in-office and out-of-office blood pressure measurements for diagnosis.
- Reviewing current and emerging pharmacologic and device-based therapies.
Main Results:
- Resistant hypertension is associated with higher cardiovascular risk.
- Secondary causes of hypertension are more prevalent in RH patients.
- Multidisciplinary approaches and optimizing current therapies are key.
Conclusions:
- Accurate diagnosis and management of resistant hypertension are crucial for reducing cardiovascular events.
- Lifestyle modifications, medication adherence, and addressing secondary causes are essential.
- A coordinated, multidisciplinary team approach is vital for optimal patient outcomes.
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