Resistant hypertension

SUMMARY POINTS 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 thoroug...

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Bibliographic Details
Published in:BMJ (Online) 2012-11, Vol.345 (7884), p.40-45
Main Authors: Myat, Aung, Redwood, Simon R, Qureshi, Ayesha C, Spertus, John A, Williams, Bryan
Format: Article
Language:English
Subjects:
Alcohol
Amphetamines
Angiotensin-converting enzyme inhibitors
Antihypertensives
Blood
Blood pressure
Body weight loss
Calcium channel blockers
Cardiovascular disease
CLINICAL REVIEW
Clinical trials
Denervation
Dietary intake
Diuretics
Dosage
Drug dosages
Heart
Hematuria
Humans
Hypertension
Hypertension - diagnosis
Hypertension - etiology
Hypertension - therapy
Obesity
Patients
Population
Potassium
Practice Guidelines as Topic
Renal artery
Symptoms
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Summary:SUMMARY POINTS 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 assessmentto exclude apparent or pseudo-resistant hypertension Post 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 population Patients 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 agents Studies 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 population No 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
ISSN:0959-8138
1756-1833
1756-1833
DOI:10.1136/bmj.e7473