Resistant hypertension

Abstract

The publication of the first non-randomised proof-of-concept trial of renal denervation as a treatment modality in treatment- -resistant hypertension set the stage for a search for novel devices with the expectation that technology would reduce the burden of hypertension by reducing or eliminating the costly and lifelong use of blood pressure-lowering medications. As we demonstrate in this review, this idea was so attractive to manufacturers and invasive cardiologists and radiologists that they overlooked decades of careful pathophysiological research in a disease that remains enigmatic but is still a major cause of cardio-vascular mortality worldwide. To make our point, we first reviewed the prevalence and risks associated with treatment-resistant hypertension. Next, we highlighted the key points required for the diagnosis of treatment-resistant hypertension, including the recording of ambulatory blood pressure and the assessment of adherence to medication. Finally, we summarised new insights in the management of treatment-resistant hypertension by medication and devices as well as in future research. Throughout our review, we focused on new evidence that had become available since 2013. Our conclusion is that optimising medical treatment based on simple algorithms remains the state of the art in treatment-resistant hypertension.

Drug Profile and Therapeutic Adherence of African-Brazilians with Apparent Resistant Hypertension

“…Similarly, the averages of the daily doses of the RH is defined as uncontrolled in-office blood pressure (≥ 140 / 90mm Hg) despite the use of 3 or more antihypertensive drugs in adequate doses, preferably including a diuretic. [6][7][8][9] Hypertension is also considered resistant when pressure control is obtained (< 140/90 mm Hg), but only with the use of 4 or more drugs. 6,7,9 In addition to the higher prevalence of RH in the black population, African-origin patients tend to have pressure levels that are more resistant to treatment.…”

“…7,10 However, it is worth mentioning that for the definitive diagnosis of true RH, it is necessary to thoroughly check the patient's therapeutic adherence, since pseudoresistance is often due to poor adherence and / or inadequate therapeutic regimen. [6][7][8]11 In situations where the patient presents only blood pressure criteria and those referring to the number of antihypertensive drugs for the diagnosis of RH, but there is no exclusion of pseudoresistance after systematic verification of therapy and adherence, the diagnosis is of apparent resistant hypertension (apparent RH). 9 Thus, in view of the morbidity and mortality associated with SH and the importance of an effective blood pressure control, we decided to investigate the drug profile and therapeutic adherence of black people with the diagnosis of apparent RH.…”

“…Regarding the diagnosis of RH, it is imperative to rule out potential causes for the difficult control of blood pressure, highlighting the inappropriate choice of antihypertensives, poor therapeutic adherence, the effect of white coat hypertension, and secondary hypertension. [6][7][8] For the treatment of RH, the recommended therapeutic regimen should include oral antihypertensive drugs with complementary pharmacodynamics. With this, as an ideal therapy, treatment with 3 drugs is recommended, including a thiazide or thiazide-type diuretic (preferably chlorthalidone), a blocker of the renin-angiotensinaldosterone system (ARB or ACEI) and a dihydropyridine calcium channel blocker (CCB), in full tolerated doses and at appropriate intervals.…”

A young patient with left ventricular hypertrophy and accidentally discovered aortic dissection: hypertensive heart disease or hypertrophic cardiomyopathy?

“…The patient was managed conservatively with strict BP control, intensified antihypertensive treatment (metoprolol, telmisartan, torasemide, spironolactone, amlodipine, clonidine), and close follow -up. 1 Secondary causes of hypertension, including renal artery stenosis, abnormal kidney and adrenal glands, hyperaldosteronism, hyperand hypothyroidism, were excluded.…”

Comparação dos efeitos anti-hipertensivos da S-nitrosoglutationa livre e nanoencapsulada em modelo animal de hipertensão

“…Em 2010, a hipertensão arterial foi a maior causa única de mortes no mundo (POULTER; PRABHAKARAN; CAULFIELD, 2015) Segundo a Organização Mundial da Saúde (OMS) menos de 1 em cada 5 indivíduos hipertensos apresenta um quadro de hipertensão arterial controlada (WORLD HEALTH ORGANIZATION, 2019). No que diz respeito à hipertensão arterial resistente, os dados epidemiológicos divergem entre si, reportando que dentre os indivíduos hipertensos 7% a 66% possuem hipertensão arterial resistente (BRAAM et al, 2017;HYMAN;PAVLIK, 2015;WEI et al, 2018). Nos Estados Unidos, cerca de 53% dos adultos hipertensos que fazem terapia medicamentosa apresentam pressão arterial não controlada (CASEY et al, 2019).…”