Key result
Resistant hypertension requires out-of-office BP monitoring, adherence checks, and aldosterone antagonists.
This review outlines the clinical diagnosis and stepwise management of resistant hypertension, emphasizing out-of-office BP measurement, aldosterone antagonists, and reserving renal denervation for severe cases.
Reinforces guideline-based evaluation and aldosterone antagonist use in resistant hypertension; leaves open optimal sequencing of emerging therapies.
Resistant hypertension (RHT) is variably defined as insufficient blood pressure (BP) response to multiple drug treatment. Prevalence of RHT has been thoroughly studied in the recent years, ranging from about 5 to 30 % in various cohorts. Initial management of patients with apparent RHT requires identification of true treatment resistance by out-of-office BP measurements, assessment of adherence and screening for treatable causes of uncontrolled BP. Endorsement of lifestyle modifications and maximisation of the doses of a suitable regimen, preferably with the further addition of an aldosterone antagonist, are the mainstay of treatment. An invasive approach to RHT, mainly represented by renal nerve ablation, should be kept for persistently severe cases managed in a specialised hypertension centre.
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Tsioufis et al. (2016) conducted a review in Resistant hypertension. Management of resistant hypertension was evaluated. Resistant hypertension, with an estimated prevalence of 5 to 30%, requires out-of-office blood pressure measurements, adherence assessment, and optimized regimens including aldosterone antagonists.
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