Resistant hypertension: a therapeutic challenge

Abstract

In 2008, the American Heart Association published resistant hypertension (RH) guidelines.1 Since that year, there has been a lot of research regarding the relevance of making a proper diagnosis and choosing the best treatment. In recent years, there has been an increasing interest in RH because uncontrolled RH is a pathological condition with a poor prognosis.In this regard, it is important to follow steps with the purpose of ruling out pseudoresistant hypertension and then excluding secondary causes. Suboptimal drug therapy, poor adherence to medications, white-coat effect, and inaccurate BP measurement are the most prev- It is difficult to establish the actual prevalence of true RH. Some series have reported a variable prevalence from 2% to 40%, depending on the criteria and the accuracy of the diagnostic procedures. 9,10All guidelines advise the use of three kinds of drugs for treatment:antagonists of the renin-angiotensin system (angiotensin-converting enzyme inhibitors or angiotensin II antagonists), calcium channel blockers, and diuretics, preferably long-lasting agents such as chlorthalidone. All agents must be prescribed at the best doses tolerated and at the optimal regimen of administration. Furthermore, if blood pressure is not under control, a fourth drug should be added. There are some controversies about whether the choice of this fourth drug should be empirically guided or guided by renin profile.To answer these questions, we must consider the paradigmatic tri- In addition, the registries of real-world patients treated with RD, which, taken together, support the safety and efficacy of RD.However, this conclusion must be reached through randomized controlled trials. [16][17][18][19] RH is characterized by an overexpression of humoral and hormonal factors that are involved in the development and maintenance of target organ damage (TOD). In this regard, mineralocorticoid receptor blockade has been proven effective and safe in the treatment of hypertension. Renin-angiotensin system blockade alone is not enough

Predictors of Resistance Hypertension and Achievement of Target Blood Pressure Levels in Patients with Resistant Hypertension

“…An estimated 10-30% of hypertensive patients are resistant to treatment defined as uncontrolled blood pressure (BP) with the use of ≥3 medications, including a diuretic [4][5][6][7][8][9][10]. A large number of studies have demonstrated that patients with resistant hypertension compared with patients with controlled hypertension have significantly a higher rate of target organ damage; increased cardiovascular risk, including coronary heart disease, chronic kidney disease, congestive heart failure, and stroke; and a significantly poorer prognosis than those of nonresistant hypertensive patients [3,11].…”