Resistant hypertension

Resistant hypertension is a type of high blood pressure that is challenging to control despite treatment with multiple medications. It is defined as blood pressure that remains above goal levels despite adherence to optimal doses of three antihypertensive medications, including a diuretic, from different drug classes.

Here are some key points about resistant hypertension:

Definition: Resistant hypertension is typically diagnosed when a person’s blood pressure remains above target levels (usually systolic blood pressure ≥ 130 mm Hg or diastolic blood pressure ≥ 80 mm Hg) despite being treated with an appropriate combination of three or more antihypertensive medications, including a diuretic.

Contributing Factors: Several factors can contribute to the development of resistant hypertension, including:

Inadequate adherence to prescribed medications or lifestyle modifications.
Secondary causes of hypertension, such as renal artery stenosis, primary aldosteronism, obstructive sleep apnea, or renal parenchymal disease.
Lifestyle factors such as obesity, excessive alcohol consumption, high sodium intake, and physical inactivity.
Medication-related factors such as incorrect dosing, drug interactions, or use of medications that can raise blood pressure (e.g., nonsteroidal anti-inflammatory drugs, decongestants).
Evaluation: Evaluation for resistant hypertension involves a thorough assessment to identify potential secondary causes and contributing factors. This may include:

Detailed medical history and physical examination.
Laboratory tests to assess kidney function, electrolyte levels, and hormone levels.
Imaging studies (e.g., renal ultrasound, renal artery imaging) to evaluate for structural abnormalities.
Sleep studies to assess for obstructive sleep apnea.
Ambulatory blood pressure monitoring to confirm the diagnosis and assess blood pressure patterns over a 24-hour period.
Treatment: Treatment of resistant hypertension focuses on addressing underlying causes and optimizing management strategies. This may involve:

Ensuring adherence to prescribed medications and lifestyle modifications.
Identifying and treating secondary causes of hypertension.
Adjusting medication regimens, including optimization of dosages, addition of complementary drug classes, or consideration of newer agents.
Implementing lifestyle modifications such as weight loss, dietary changes (e.g., reducing sodium intake), regular physical activity, and stress reduction techniques.
Referral to a hypertension specialist or multidisciplinary team for further evaluation and management.
Prognosis: Resistant hypertension is associated with an increased risk of cardiovascular events such as heart attack, stroke, heart failure, and kidney disease. However, with appropriate management and adherence to treatment recommendations, blood pressure control and reduction in cardiovascular risk can be achieved.

Individuals with suspected resistant hypertension should work closely with healthcare professionals, including primary care providers, cardiologists, and hypertension specialists, to undergo comprehensive evaluation and develop personalized treatment plans tailored to their specific needs and circumstances. Close monitoring and ongoing support are essential for optimizing blood pressure control and reducing the risk of complications associated with resistant hypertension.

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