Treatment of refractory hypertension

Area of Science:

• Cardiology
• Pharmacology

Background:

• Refractory hypertension poses a significant clinical challenge, often persisting despite standard stepped-care regimens.
• Conventional treatments including diuretics, beta-blockers, and vasodilators may be insufficient for some patients.

Purpose of the Study:

• To compare the efficacy and tolerability of different treatment approaches for patients with uncontrolled, severe hypertension.
• To evaluate oral diazoxide, minoxidil, captopril, and quadruple therapy in refractory hypertension.

Main Methods:

• A comparative assessment involving 126 patients with inadequately controlled high blood pressure.
• Four treatment regimens were administered: oral diazoxide, minoxidil, captopril, or quadruple therapy (diuretic + beta-adrenoceptor blocker + hydralazine + prazosin).

Main Results:

• Blood pressure control was achieved in nearly all patients, with no cerebrovascular deaths during treatment.
• Adverse events included renal failure (2 deaths, 5 requiring haemodialysis) and ischaemic heart disease (10 deaths).
• Diazoxide showed high efficacy but poor tolerability; captopril was well-tolerated but less effective in some cases.

Conclusions:

• Effective therapeutic alternatives now exist for managing refractory hypertension, offering better blood pressure control.
• While significant progress has been made, challenges remain in optimizing treatment to avoid adverse events and ensure ideal outcomes.