How will the growing threat of resistant hypertension impact the future treatment of high blood pressure?

Abstract

Hypertension treatment and control efforts represent a major component of primary care with dedicated clinical guidelines and recommendations. However, high blood pressure (BP) control rates are complicated with the difficult to treat and resistant hypertensive patients. This category of patient, therefore, affects the development and implementation of the clinical guidelines. The recommendations of specific algorithms for resistant hypertension and difficult-to-treat patients with elevated BPs have been developed in consideration of new therapies and combination drug treatment. Hypertension treatment guidelines include and will continue to grade evidence from randomized clinical trials with detailed strategies on the management of these high-risk patients. Although resistant hypertension affects high BP control rates, the inclusion of refined pharmaceutical and device treatment strategies in evidence-based guidelines will be expected to have a significant impact on the clinical management of this high-risk patient population.

Keywords::

• high blood pressure control
• hypertension guidelines
• implementation
• resistant hypertension

Financial & competing interests disclosure

The author has no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

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

Key issues

• • Clinical guidelines for the treatment and management of high blood pressure (BP) represent a resource for resistant and difficult to treat hypertension. High BP treatment guidelines should include current and evidence-based strategies to address resistant and refractory hypertension.

• • Resistant hypertension is defined as BP that remains above goal with concurrent use of three antihypertensive agents of different classes, or BP that is controlled with four or more medications. Pseudoresistant hypertension refers to hypertension resulting from inaccurate measurement of BP (e.g., use of an inappropriately small BP cuff), poor adherence to antihypertensive therapy or white coat hypertension.

• • Although high BP control is improving in the population, the rate remains suboptimal as nearly one in four treated hypertensives are not at goal BP levels. Resistant hypertension contributes to the lack of control among individuals with high BP.