title: Management of refractory hypertension.
abstract: True refractory hypertension is unusual in clinical practice, thanks to the widespread availability of antihypertensive drugs and national mandate to optimize blood pressure control levels in the community. However, at times the blood pressure may become refractory to initial drug therapy. When the blood pressure levels do not reach a target level despite usual therapy, hypertension is considered refractory. There should be proper evaluation of such patients to determine the factor(s) responsible for resistance to therapy. In many patients, proper adjustment of drug doses, including effective use of diuretics, restores the blood pressure level. For some patients, potent drug therapy, such as hydralazine or minoxidil, must be considered. Based upon clinical course, work-up for secondary causes of hypertension should be considered in selected patients. Refractory hypertension requires proper analysis of etiologic factors and consideration of rational drug selection, and at times, work-up for secondary causes of hypertension.
authors.affiliation: Texas Blood Pressure Institute, Dallas Nephrology Associates, University of Texas Southwestern Medical Center, 13154 CoitRoad, Suite 100, Dallas, TX 75240, USA. ramv@dneph.com
authors.forename: C Venkata S
authors.initials: CV
authors.lastname: Ram
mesh_terms: D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D004232:Diuretics / Q000494:pharmacology / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology; D008019:Life Style
chemical_list: D000959:Antihypertensive Agents; D004232:Diuretics