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Resistant hypertension: what to do after trying 'the usual'
1Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, USA.
Geriatrics
|May 1, 1995
Summary
Resistant hypertension, defined by high blood pressure despite three medications, often stems from lifestyle factors or secondary causes like renovascular disease. Treatment adjustments typically resolve most cases.
Area of Science:
- Cardiology
- Nephrology
- Internal Medicine
Background:
- Resistant hypertension is diagnosed when diastolic blood pressure exceeds 90 mm Hg despite full doses of three antihypertensive agents.
- Common contributors include suboptimal medication, patient noncompliance, obesity, smoking, alcohol use, and "office hypertension."
- Physiologic causes often involve volume overload or secondary hypertension, notably renovascular disease.
Purpose of the Study:
- To outline the definition, causes, diagnostic approaches, and management strategies for resistant hypertension.
Main Methods:
- Review of literature and clinical guidelines concerning resistant hypertension.
- Discussion of diagnostic criteria and common contributing factors.
- Evaluation of screening tests like the captopril challenge and definitive tests such as renal arteriography.
Main Results:
- Inadequate regimens and patient-related factors are frequent causes of uncontrolled blood pressure.
- Renovascular disease is a key secondary cause requiring prompt investigation.
- The captopril challenge serves as an effective initial screening tool for renovascular hypertension.
Conclusions:
- Most cases of true resistant hypertension can be effectively managed by optimizing the antihypertensive medication regimen.
- Identifying and addressing underlying causes like volume overload or renovascular disease is crucial for successful treatment.