Resistant hypertension

Resistant hypertension is defined as high blood pressure that remains uncontrolled despite treatment with at least three antihypertensive agents (one of which is usually a diuretic) at best tolerated doses. A diagnosis of true resistant hypertension should be made only after a thorough assessment to exclude apparent or pseudo-resistant hypertensionPost hoc analyses of large scale trials of antihypertensive drugs plus retrospective cross sectional observational studies point to a prevalence of resistant hypertension of 10-20% of the general hypertensive populationPatients with resistant hypertension are almost 50% more likely to experience an adverse cardiovascular event compared with patients with blood pressure controlled by three or fewer antihypertensive agentsStudies indicate that 5-10% of resistant hypertension patients have an underlying secondary cause for their elevated blood pressure—a prevalence significantly greater than that of the general hypertensive populationNo clinical trials have compared the effectiveness of specific drug regimens for the treatment of resistant hypertension. The best available evidence supports the use of low dose spironolactone as the preferred fourth drug if the patient’s blood potassium level is ≤4.5 mmol/L. With higher blood potassium levels, intensification of thiazide-like diuretic therapy should be considered Renal sympathetic denervation therapy, as a device based intervention, could potentially stimulate a paradigm shift in the management of resistant hypertension