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Resistant Hypertension: Pathophysiology, Diagnostic Approaches, and Emerging Therapeutic Strategies
Manjappa Mahadevappa1, Himabindu Jayaprakash Narayan2, Bharath Raj Srinivasan2
1Department of Cardiology, JSS Medical College and Hospital, Mysuru JSSAHER, Mysuru, Karnataka, 570004, India.
Current Hypertension Reviews
|April 13, 2026
Summary
Resistant hypertension (RH) affects up to 10% of patients, often due to complex factors like sympathetic overactivity and aldosterone excess. Emerging therapies, including device-based approaches and new agents, show promise for better blood pressure control.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Resistant hypertension (RH) is defined as uncontrolled blood pressure (BP) despite three antihypertensive agents and a diuretic.
- RH affects up to 10% of hypertensive individuals globally, with higher prevalence in patients with chronic kidney disease and obstructive sleep apnea.
Purpose of the Study:
- To review the pathophysiology, diagnostic criteria, and emerging therapeutic strategies for managing resistant hypertension.
- To highlight current clinical challenges and future directions in RH management.
Main Methods:
- A narrative review of English language literature from January 2000 to June 2025.
- Searches included terms like "resistant hypertension," "renal denervation," and "aldosterone."
- Prioritized guidelines, RCTs, meta-analyses, and relevant observational studies.
Main Results:
- Misdiagnosis and poor adherence are common issues in RH.
- Pathophysiology involves sympathetic overactivity, RAAS dysregulation, and aldosterone excess.
- Promising treatments include mineralocorticoid receptor antagonists, aldosterone synthase inhibitors, renal denervation, and baroreceptor therapies.
Conclusions:
- Optimizing pharmacotherapy and assessing adherence are crucial for RH management.
- Emerging agents and device-based approaches offer potential for improved BP control.
- Further validation and addressing accessibility are needed for novel RH therapies.
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