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April 13, 2026Current Hypertension Reviews

Resistant hypertension affects up to 10% of hypertensive patients globally; integrating optimized pharmacotherapy and emerging options like aldosterone synthase inhibition, dual endothelin receptor antagonism, small-interfering RNA strategies, and device-based approaches offers incremental BP reductions.

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Why the study?

This review was conducted to examine the pathophysiology, diagnostic criteria, and emerging therapeutic strategies in resistant hypertension management, emphasizing current clinical challenges and future directions.

Design

Narrative (non-systematic) review

Authors

MMManjappa MahadevappaHNHarini NarayanBSBharath Raj Srinivasan

Discussion

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Overview

Clinicians should integrate adherence assessment, secondary cause evaluation, and pharmacologic intensification in resistant hypertension; extends options with aldosterone synthase inhibitors and device therapy.

Key Points

  • The aim is to review the pathophysiology, diagnostic criteria, and emerging therapeutic strategies for resistant hypertension.
  • Conducted a narrative review using PubMed and Scopus databases.
  • Focused on literature from January 2000 to June 2025.
  • Prioritized guidelines, randomized controlled trials, and systematic reviews relevant to resistant hypertension.
  • Resistant hypertension affects up to 10% of global hypertensive patients.
  • Prevalence is higher in those with chronic kidney disease and obstructive sleep apnea.
  • Misdiagnosis and poor medication adherence are significant challenges.
  • Promising treatments include mineralocorticoid receptor antagonists, renal denervation, and baroreceptor therapies.

Structured PICO

P
Population
Patients with resistant hypertension (defined as blood pressure remaining uncontrolled despite concurrent use of three antihypertensive agents from different classes, including a diuretic).
I
Intervention
Diagnostic approaches and therapeutic strategies including lifestyle modifications, mineralocorticoid receptor antagonists, aldosterone synthase inhibitors, renal denervation, baroreceptor therapies, zilebesiran, and aprocitentan.

A multidimensional approach integrating adherence assessment, secondary cause evaluation, pharmacologic intensification, and selective device therapy is critical for achieving durable blood pressure control in resistant hypertension.

Limitations

  • lack of large-scale comparative trials
  • accessibility concerns in low-resource settings

Cite This Study

Mahadevappa et al. (2026) studied this question.

synapsesocial.com/papers/69dc88b93afacbeac03ea713https://doi.org/10.2174/0115734021429097260401053734
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