Resistant hypertension: diagnosis and management.
The incidence of resistant hypertension, the failure to reduce blood pressure below 140/90 mm Hg, despite the use of 3 antihypertensive medications at optimal doses including a diuretic, is estimated to be less than 5% of the hypertensive population. Resistant hypertension increases the risk of stroke, myocardial infarction, congestive heart failure, and renal failure. Evaluation of the patient with resistant hypertension should include 24-hour ambulatory blood pressure monitoring or home measurements and a limited search for secondary causes. Treatment should focus on optimizing the drug regimen in a logical way, based on the patient's comorbidities and tolerability. Long-acting, well-tolerated once-daily medications are preferred, and the regimen should include in sequence a diuretic, beta-blocker, angiotensin-converting enzyme/angiotensin receptor-blocker inhibitors, and a calcium-channel blocker. This article reviews the definitions and causes and provides specific recommendations for the evaluation and management of patients with this life-threatening condition.
Papadopoulos
Dimitris P
DP
Hypertension and Cardiovascular Research Clinic, Georgetown University/VAMC 151-E, 50 Irving Street NW, Washington, DC 20422, USA. papavip@aol.com
Papademetriou
Vasilios
V
D000818:Animals; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001810:Blood Volume / Q000502:physiology; D004351:Drug Resistance; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy* / Q000523:psychology; D009626:Terminology as Topic
D000959:Antihypertensive Agents