Characterization and treatment of resistant hypertension

Abstract

Resistant hypertension is a common medical problem and carries a significantly increased risk of end organ damage and cardiovascular events as compared with more easily controlled hypertension. Resistant hypertension is most often related to isolated systolic hypertension and is characterized by aldosterone excess and increased intravascular volume. Its diagnosis requires the exclusion of pseudoresistance. The etiology of resistant hypertension is almost always multifactorial and common reversible contributing factors need to be identified and addressed. Secondary causes of hypertension such as primary aldosteronism, parenchymal and vascular kidney disease, and obstructive sleep apnea require investigation and effective treatment if present. Therapy for resistant hypertension should be based on use of rational drug class combinations at optimal doses with particular attention to adequate diuretic use. The addition of an aldosterone antagonist may further improve blood pressure control.

Assessing Medication Default, Alcohol Intake and Smoking Habits among Hypertensive Patients in a Rural Village of Limpopo Province, South Africa

“…This scenario especially among hypertensive patients can be a recipe for disaster because alcohol can interfere with the efficacy of some blood pressure medications and can also contribute to medication default. Since it is established that cessation of heavy alcohol consumption leads to a reduction in 24 hour ambulatory systolic blood pressure and diastolic blood pressure of 7.2 and 6.6mmhg, respectively (Pisoni et al, 2009), it will be medically prudent for hypertensive patients to resort to moderate drinking or quit alcohol intake completely.…”

Going beyond the optimization of pharmacotherapy

“…However, given that up to 35% of patients (from clinical trial data) may have resistant hypertension, an additive approach such as that described by Ceral et al will be a welcome technique for selected patients. 9 Second, as the authors report, this technique offers a simple binary outcome of whether certain patients are taking their medications or not. The utility would be reserved for those whose disease is deemed severe and in whom an evaluation of serum drug level is important enough to warrant corrective measures that would otherwise have been substituted by a comprehensive platform of further investigations of other pathological causes for resistant hypertension.…”

“…9 All the multi-targeted measures employed to reduce blood pressure will be in vain if a patient neither takes the tablet nor adheres to a specific strategy, either intentionally or otherwise.…”

Resistant Hypertension

“…Resistant hypertension itself, the causes of which are shown in Table 1, may only be diagnosed after having excluded all the above-mentioned factors [11].…”