Management Strategies for Treatment-Resistant Hypertension: Current Status and Future Outlook

Hypertension affects >1 billion individuals worldwide. Despite the availability of effective antihypertensive therapy, the prevalence of treatment-resistant hypertension (TRH), defined as uncontrolled hypertension despite the use of ≥3 antihypertensive agents at optimum doses, is reported to be 5 to 30% of the hypertensive population. Uncontrolled hypertension contributes to an elevated risk of stroke, myocardial infarction, heart failure, and kidney failure. TRH is associated with a 50% higher risk of cardiovascular disease than controlled hypertension. Several factors contribute to apparent treatment resistance, including poor medication adherence, physician inertia, inadequate doses or inappropriate combinations of antihypertensive drugs, excess salt and alcohol intake. The pathophysiology underlying true TRH remains unclear. In this article, we discuss the factors responsible for apparent treatment resistance in hypertension and the management strategies, including device therapy and newer antihypertensive agents that are likely to be available in the near future.