Recent advances in understanding and managing resistant/refractory hypertension

Abstract

The management of resistant hypertension presents several challenges in everyday clinical practice. During the past few years, several studies have been performed to identify efficient and safe pharmacological and non-pharmacological options for the management of such patients. The Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2) trial demonstrated significant benefits with the use of spinorolactone as a fourth-line drug for the treatment of resistant hypertension over doxazosin and bisoprolol. In addition, recent data support that spironolactone may demonstrate superiority over central acting drugs in such patients, as well. Based on the European guidelines, spironolactone is recommended as the fourth-line drug option, followed by amiloride, other diuretics, doxazosin, bisoprolol or clonidine. Among several device-based approaches, renal sympathetic denervation had fallen into hibernation after the disappointing results of the Renal Denervation in Patients With Uncontrolled Hypertension (SYMPLICITY HTN) 3 trial. However, the technique re-emerged at the epicenter of the clinical and research interest after the favorable results of three sham-controlled studies, which facilitated novel catheters and techniques to perform the denervation. Significant results of iliac anastomosis on blood pressure levels have also been demonstrated. Nevertheless, the technique-related adverse events resulted in withdrawal of this interventional approach. Last, the sympatholytic properties of the carotid baroreceptor activation therapy were associated with significant blood pressure reductions in patients with resistant hypertension, which need to be verified in larger controlled trials. Currently device-based approaches are recommended only in the setting of clinical trials until more safety and efficacy data become available.

Effects of Carvedilol on Blood Pressure, Blood Sugar, and Blood Lipids in Elderly Patients with Refractory Hypertension

“…The prevalence of refractory hypertension has increased gradually over a 20-year period, which may be related to the increased awareness, treatment, and management of hypertension in the United States and certainly to the increasing prevalence of aging and obesity [ 4 ]. We speculate that the prevalence of true refractory hypertension may not be high and that many patients may have pseudorefractory hypertension due to irrational medication use and poor compliance [ 5 ]. Carvedilol is a nonselective β -blocker that blocks β receptors comprehensively and also selectively blocks α 1 receptors, without endogenous sympathomimetic activity or peripheral β agonism [ 6 ].…”

Stress and hypertension: C and H type of hypertension and causes of resistance

“…Обов'язковим є також повторне обстеження пацієнта через 3-6 місяців після корекції факторів ризику і немедикаментозної терапії. При збереженні підвищеного рівня АТ (особливо коли підвищеним є середньодобовий АТ і відсоток підвищених показників становить > 25-30 %) вирішується питання про призначення медикаментозної терапії [72][73][74][75][76][77][78][79][80][81][82][83][84][85][86][87][88][89][90][91].…”

Device-Based Therapy for Resistant Hypertension: An Up‐to‐Date Review

“…(1) RDN is the most developed therapy for RH and has already proved its feasibility through multiple trials and large RCTs. Furthermore, plenty of ink has been spilled in the literature, which has excessively reviewed this therapy with much more attention than the other therapies [15,[25][26][27][28][29], presenting an overall of more than 70% of RH therapy coverage. (2) More than ten RDN systems are clinically approved and have been given the CE mark.…”