Resistant hypertension: diagnosis and management.

Area of Science:

• Cardiology
• Pharmacology

Background:

• Resistant hypertension, failing to respond to standard drug regimens, is rare.
• Common reasons for apparent treatment failure include poor patient compliance, excessive salt intake, drug interactions, inaccurate readings, or secondary hypertension.
• Understanding the mechanisms of resistance is key to effective management.

Purpose of the Study:

• To review the causes of hypertension resistant to medical treatment.
• To discuss strategies for managing resistant hypertension by identifying underlying mechanisms.
• To introduce potential new pharmacologic agents for resistant hypertension.

Main Methods:

• Literature review of causes and management of resistant hypertension.
• Discussion of hemodynamic and humoral factors contributing to resistance.
• Overview of investigational drugs targeting total peripheral resistance.

Main Results:

• Most cases of apparent resistant hypertension have identifiable causes other than true drug resistance.
• Tailoring treatment based on specific hemodynamic and humoral profiles can improve outcomes.
• Newer agents like minoxidil and oral converting enzyme inhibitors show promise.

Conclusions:

• True resistant hypertension is rare, with most cases attributable to secondary factors or non-compliance.
• Personalized therapeutic approaches targeting specific resistance mechanisms are crucial.
• Emerging pharmacotherapies offer new hope for managing refractory hypertension.