Resistant and refractory hypertension: two sides of the same disease?

Abstract

Refractory hypertension (RfH) is an extreme phenotype of resistant hypertension (RH), being considered an uncontrolled blood pressure besides the use of 5 or more antihypertensive medications, including a long-acting thiazide diuretic and a mineralocorticoid antagonist. RH is common, with 10-20% of the general hypertensives, and its associated with renin angiotensin aldosterone system hyperactivity and excess fluid retention. RfH comprises 5-8% of the RH and seems to be influenced by increased sympathetic activity. RH patients are older and more obese than general hypertensives. It is strongly associated with diabetes, obstructive sleep apnea, and hyperaldosteronism status. RfH is more frequent in women, younger patients and Afro-americans compared to RFs. Both are associated with increased albuminuria, left ventricular hypertrophy, chronic kidney diseases, stroke, and cardiovascular diseases. The magnitude of the white-coat effect seems to be higher among RH patients. Intensification of diuretic therapy is indicated in RH, while in RfH, therapy failure imposes new treatment alternatives such as the use of sympatholytic therapies. In conclusion, both RH and RfH constitute challenges in clinical practice and should be addressed as distinct clinical entities by trained professionals who are capable to identify comorbidities and provide specific, diversified, and individualized treatment.

Resistant hypertension: Prevalence and profile of patients followed in a university ambulatory

“… 10 , 11 Refractory hypertension is defined as a special subgroup of hypertensive patients who keep their BP uncontrolled (BP ⩾ 140/90 mmHg) even using five or more antihypertensive drug classes, including a properly diuretic, considering their fluid status and renal function, and for whom spironolactone has been added to the treatment plan. 10 – 12 …”

Salt-dependent hypertension and inflammation: targeting the gut–brain axis and the immune system with Brazilian green propolis

“…Currently, treatment of SAH uses a variety of drugs already available on market such as angiotensin-converting enzyme (ACE) inhibitors, AT 1 receptor antagonists, calcium channel inhibitors, diuretics, and beta-blockers (Bouhanick et al 2019). However, about 20% of the hypertensive population has resistance to conventional treatment (Carey et al 2018;Daugherty et al 2012;Muxfeldt et al 2019). Within this population of patients resistant to treatment, about 8% develop refractory arterial hypertension, which is set at the moment that SAH treatment fails to reduce BP despite the use of 5 or more classes of anti-hypertensive drugs (Muxfeldt et al 2019).…”

“…However, about 20% of the hypertensive population has resistance to conventional treatment (Carey et al 2018;Daugherty et al 2012;Muxfeldt et al 2019). Within this population of patients resistant to treatment, about 8% develop refractory arterial hypertension, which is set at the moment that SAH treatment fails to reduce BP despite the use of 5 or more classes of anti-hypertensive drugs (Muxfeldt et al 2019). Based on the statistics regarding patients resistant and refractory to conventional treatment of hypertension, new therapeutic tools and medicine are required to treat such condition.…”

Biomarker-based Inflammatory Score in Obese Patients with Resistant Hypertension

“…1 , 2 The controlled RAH is also currently recognized as that in which patients using four or more medications reached the blood pressure target; and refractory AH, an entity that has a different pathophysiology from RAH, when even the four drugs are not enough to control it. 4 According to this new classification, patients with pseudohypertension should be excluded, that is, it is mandatory for diagnostic confirmation to verify adherence and tolerance to medication; to rule out white-coat hypertension; and thus, it is crucial to perform systematized blood pressure measurements outside the office environment through Ambulatory BP Monitoring (ABPM) or Home BP Measurement (HBPM); and finally, the use of a correct and reliable BP measurement technique. 1 , 2 , 4 , 5…”

“…4 According to this new classification, patients with pseudohypertension should be excluded, that is, it is mandatory for diagnostic confirmation to verify adherence and tolerance to medication; to rule out white-coat hypertension; and thus, it is crucial to perform systematized blood pressure measurements outside the office environment through Ambulatory BP Monitoring (ABPM) or Home BP Measurement (HBPM); and finally, the use of a correct and reliable BP measurement technique. 1 , 2 , 4 , 5…”