Diagnosis and treatment of resistant hypertension

Abstract

Hypertension resistant to lifestyle interventions and antihypertensive medications is a common problem encountered by physicians in everyday practice. It is most often defined as a blood pressure remaining ≥ 140/90 mmHg despite the regular intake of at least three drugs lowering blood pressure by different mechanisms, one of them being a diuretic. It now appears justified to include, unless contraindicated or not tolerated, a blocker of the renin–angiotensin system and a calcium channel blocker in this drug regimen, not only to gain antihypertensive efficacy, but also to prevent or regress target organ damage and delay the development of cardiorenal complications. A non-negligible fraction of treatment-resistant hypertension have normal “out of office” blood pressures. Ambulatory blood pressure monitoring and/or home blood pressure recording should therefore be routinely performed to identify patients with true resistant hypertension, i.e. patients who are more likely to benefit from treatment intensification.

Key Words::

• Ambulatory blood pressure monitoring
• combination therapy (antihypertensive medications)
• diuretic therapy
• hypertension guidelines (hypertension)
• refractory hypertension
• renin–angiotensin–aldosterone system
• self-measurement of blood pressure

Acknowledgements

This work has been partially supported by a grant of the Foundation for the Prevention of Cardiovascular Diseases (Geneva, Switzerland).

Conflicts of interest: All authors have no conflicts of interest to disclose regarding the content of this manuscript. B. Waeber has given lectures for Novartis, Astra-Zeneca and Servier. M. Volpe is a member of the Global Advisory Board on a Medtronic Registry. He has received a research grant from Novartis, and has given lectures for Daiichi-Sankyo. Dr Ruilope has served as speaker/advisor for Astra-Zeneca, Bayer, BMS, Daiichi-Sankyo, GSK, Medtronic, Menarini, Novartis, Pfizer, Recordati, Relypsa, Takeda. RE Schmieder has received research grants from Boehringer Ingelheim, Daiichi Sankyo, Medtronic, Novartis, Servier, and other pharmaceutical companies. He has given lectures and is member of advisory boards for Boehringer Ingelheim, Daiichi Sankyo, Medtronic, Novartis, Servier, and other pharmaceutical companies.