Resistant Hypertension in Adults: Evaluation and Treatment

Area of Science:

• Cardiology
• Primary Care Medicine
• Pharmacology

Background:

• Difficult-to-control hypertension is a prevalent challenge in primary care settings.
• Resistant hypertension is defined as blood pressure (BP) remaining above goal despite optimal doses of three antihypertensive agents, including a diuretic.

Purpose of the Study:

• To outline the diagnostic evaluation and management strategies for resistant hypertension in primary care.
• To emphasize the importance of accurate BP measurement and addressing contributing factors before diagnosing resistant hypertension.

Main Methods:

• Review of diagnostic criteria and management guidelines for resistant hypertension.
• Emphasis on comprehensive patient assessment including comorbidities, adherence, and secondary causes.
• Discussion of evidence-based pharmacological and non-pharmacological treatment approaches.

Main Results:

• Accurate BP measurement and assessment for nonadherence, white coat hypertension, secondary hypertension, and suboptimal therapy are crucial initial steps.
• An initial three-drug regimen should include a dihydropyridine calcium channel blocker, an angiotensin receptor blocker or ACE inhibitor, and a thiazide diuretic.
• Mineralocorticoid receptor antagonists are the preferred fourth-line option for resistant hypertension, with other agents considered based on individual patient factors.

Conclusions:

• Effective management of resistant hypertension necessitates a thorough evaluation and individualized treatment plan.
• Optimizing lifestyle interventions, medication regimens, and addressing social factors are key components of care.
• Interventional options should be considered for patients refractory to medical management.