Resistant hypertension

Resistant hypertension is a form of high blood pressure that is difficult to control despite treatment with multiple antihypertensive medications. It is defined as blood pressure that remains above target levels despite adherence to a treatment regimen that includes three or more antihypertensive medications of different classes, including a diuretic, at optimal doses.

Here are some key points about resistant hypertension:

  1. Prevalence: Resistant hypertension is estimated to affect about 10% to 15% of individuals with hypertension. It is more common in older adults, individuals with obesity, those with chronic kidney disease, and people with obstructive sleep apnea.
  2. Causes: There are several factors that can contribute to the development of resistant hypertension, including:
    • Inadequate treatment regimen: This may include incorrect drug selection, suboptimal dosing, poor adherence to medication, or inadequate lifestyle modifications.
    • Renal artery stenosis: Narrowing of the renal arteries can lead to resistant hypertension.
    • Secondary hypertension: Underlying medical conditions such as chronic kidney disease, primary aldosteronism, obstructive sleep apnea, or pheochromocytoma may cause or contribute to resistant hypertension.
    • Lifestyle factors: Obesity, excessive sodium intake, inadequate physical activity, and excessive alcohol consumption can all contribute to resistant hypertension.
  3. Evaluation: When evaluating a patient with suspected resistant hypertension, healthcare providers typically conduct a thorough assessment to identify potential causes and contributing factors. This may include:
    • Comprehensive medical history and physical examination
    • Laboratory tests to assess kidney function, electrolyte levels, and other relevant parameters
    • Imaging studies such as renal ultrasound or renal artery imaging to evaluate for structural abnormalities
    • Screening for secondary causes of hypertension, especially if clinical suspicion is high
  4. Management: Management of resistant hypertension involves addressing modifiable risk factors, optimizing medication regimens, and considering additional therapies. Strategies may include:
    • Lifestyle modifications: Emphasizing dietary changes (such as reducing sodium intake and adopting the DASH diet), increasing physical activity, achieving weight loss, limiting alcohol consumption, and quitting smoking.
    • Optimization of medication regimen: Ensuring adherence to prescribed medications, optimizing dosages, and considering the use of long-acting formulations or combination therapies.
    • Consideration of additional therapies: In some cases, additional interventions such as renal denervation, baroreceptor stimulation, or aldosterone antagonists may be considered for patients with true resistant hypertension.
  5. Monitoring and Follow-up: Patients with resistant hypertension require regular monitoring to assess blood pressure control, medication adherence, and response to treatment. Close follow-up with healthcare providers is essential to adjust treatment as needed and address any ongoing issues or concerns.

Overall, the management of resistant hypertension requires a comprehensive and multidisciplinary approach, involving collaboration between patients, healthcare providers, and specialists as needed to optimize blood pressure control and reduce the risk of cardiovascular complications.

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