Challenging hypertension: how to diagnose and treat resistant hypertension in daily clinical practice

Abstract

Arterial hypertension is a very complex disease characterized by a sustained rise in systolic and/or diastolic blood pressure (BP) levels and a significantly increased risk of developing major adverse cardiovascular and renal outcomes. Although BP-lowering treatment reduces the hypertension-related burden of disease, BP control continues to be poorly achieved worldwide. A major factor contributing to this therapeutic failure is represented by resistant (or refractory) hypertension. The diagnosis of ‘resistant hypertension’ is very common in clinical practice, yet it is often used to improperly define patients with difficult or challenging forms of hypertension. An incorrect use of this definition by physicians may lead to clinical behaviors that do not help to improve BP control; on the other hand, correct diagnosis of resistant hypertension may facilitate the successful treatment of hypertension. In this article, we will review and discuss the definition, pathophysiological mechanisms, diagnostic algorithms and potential new therapeutic options for treating resistant hypertension.

Keywords::

• antihypertensive treatment
• blood pressure control
• clinical inertia
• refractory hypertension
• resistant hypertension

Financial & competing interests disclosure

Massimo Volpe has received research grants and has been a speaker in several symposia sponsored by pharmacological companies producing antihypertensive agents; he has served on the international advisory boards of Merck Sharpe & Dohme, Sanofi-Aventis/Bristol Myers Squibb, Bayer Schering Pharma, Novartis Pharma, Boehringer Ingelheim, Pfizer and Daichii Sankyo. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Notes

NEP: Neutral endopeptidase.