Resistant or difficult-to-treat hypertension.
Resistant hypertension, defined as uncontrolled hypertension on three medications, is becoming an increasingly common problem. In most cases, blood pressure remains elevated because of persistently high systolic blood pressure levels. Common characteristics of patients with resistant hypertension include older age, obesity, excessive dietary salt ingestion, and presence of sleep apnea. The evaluation of patients with resistant hypertension is focused on identifying contributing and secondary causes of hypertension. Treatment should include both lifestyle changes (weight loss, exercise, dietary salt restriction) and the use of effective multidrug regimens, including a diuretic. Recent data indicate that aldosterone antagonists may be effective when added to existing antihypertensive regimens even in the absence of primary aldosteronism.
Calhoun
David A
DA
Vascular Biology and Hypertension Program, Center for Sleep/Wake Disorders, University of Alabama at Birmingham, Birmingham, AL 35294, USA. dcalhoun@uab.edu
D000428:Alcohol Drinking / Q000009:adverse effects; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D004347:Drug Interactions; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000628:therapy; D008019:Life Style; D009765:Obesity / Q000150:complications; D020181:Sleep Apnea, Obstructive / Q000150:complications; D012982:Sodium, Dietary / Q000009:adverse effects; D017211:Treatment Failure
D000959:Antihypertensive Agents; D012982:Sodium, Dietary