Progression in Diagnosis and Treatment of Resistant Hypertension

Abstract

Introduction: Resistant Hypertension (RH) is a major risk factor of numerous diseases. RH is a challenging clinical problem,many factors affect blood pressure (BP) control. Correct diagnosis and appropriate drug therapy are pretty important to get BP controlled. We aim to attract physicians' attention to adopt correct measures to diagnose and treat RH.Method: Articlesare obtained from the Internet, www.pubmed.com, Medline and several authors via e-mail.Result and Conclusion: 1.Using a systematic approach to find out the causes of RH and the distinctions between pseudo-resistance and true resistance areof importance for treatment. 2. Following the current treatment guidelines and using the standardized way to establish a flowchart to manage the patientsare the correct methods for BP control. 3. In the absence of novel antihypertensive drugs targeting new pathways, device-based therapies including RDN, carotid baroreflex activation and continuous positive airway pressure (CPAP) have shown encouraging results. 4. Further efforts on the pathophysiology of RH will help to establish better drug combinations or new ways on BP control. and treatment of RH to attract physicians' attention to adopt correct measures to diagnose and treat RH. Discussion PrevalenceStrictly speaking, RH is not a definition of disease, but of management. So it is difficult to get its correct prevalence. Because of this, its prevalence is still unclear. Some large-scale clinical trials intended to figure out the prevalence of RH in overall population and hypertensive populationare shown below.According to the latest data from ESH/ESC [1], the prevalence of RH is around 5%-30% of the overall hypertensive populationwithfigures less than 10% probably representing the true prevalence. Arepresentative survey carried out by American National Health and Nutrition Examination [2] including > 15 000 non-pregnant adults between 2003 and 2008 found that resistant hypertension criteria were met in 8.9% of all individuals with hypertension, and in 12.8% of the hypertensive drugs treated population. A complete database for 7.9 years from Olivetti Heart Study (OHS) in southern Italy [3] showed that the prevalence of RH was 4.8% in the whole study population, and 10.1% in hypertensive participants. It seems that the prevalence ofRHis around 10% in hypertensive population, butsituations including treatment adherence, white coat hypertension and secondary hypertension were not reported. Another more detailed research by Stacie et al [4] demonstrated thatafter the exclusion of those who lost baseline data or failed to adhere to the research, the inadequate number of antihypertensive drugs, and poor medication adherence,the prevalence of true RH was only 1.9%among 205750 patients. It is, Abbreviations