Why the study?
Resistant hypertension is an increasingly common issue in clinical practice and a major risk factor for cardiovascular disease.
This review emphasizes a systematic approach to resistant hypertension, prioritizing the exclusion of pseudoresistance and secondary causes, followed by optimization of medical therapy with thiazides and MRAs.
Supports stepwise medical optimization in resistant hypertension; leaves open device therapies pending randomized trials.
PURPOSE OF REVIEW: Resistant hypertension is defined as blood pressure above patient goal despite three different antihypertensive agents at optimal dose including a diuretic. Resistant hypertension is increasingly common issue in clinical practice and it is a major risk factor of cardiovascular disease. RECENT FINDINGS: All patients with resistant hypertension should be evaluated for possible correctable factors associated with pseudoresistance, such as poor adherence, white coat hypertension and suboptimal measurement of blood pressure. In patients with resistant hypertension, thiazide diuretics should be considered as one of the first agents, in addition to mineralocorticoids receptor antagonist. SUMMARY: Resistant hypertension can be associated with secondary cause that is why treatment can be challenging and should always include lifestyle modification and evaluation for possible secondary causes, in addition to adding a fourth agent or considering newer interventional therapies, such as renal denervation or other device-based options.
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Hasan et al. (2019) studied this question.
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