Patients with resistant hypertension.
Hypertension remains uncontrolled in the majority of treated patients, especially those with multiple cardiovascular risk factors. This was demonstrated by a French study that showed that 70% of treated hypertensive patients are not controlled to the target level of 140/90 mmHg. This proportion reached 84% in hypertensive patients with diabetes (target level 130/85 mmHg). What are the reasons for this disappointing situation? Observational studies have shown that only a minority of patients with uncontrolled hypertension receive triple therapy including a diuretic. In this respect, self-measurement of blood pressure should improve the situation by allowing clinicians to base their decision to intensify hypertension treatment on more solid evidence than consultation blood pressure measurements alone. Patient-related factors may also contribute to this situation. Treated patients with uncontrolled hypertension often have multiple risk factors. This is associated with or is a source of poor treatment observance linked to patient psychological factors or a result of the increased consumption of medication. Finally, risk factors themselves may be responsible for problems with blood pressure control as a result of their detrimental effects on large arteries as well as the microvascular network. The early correction of such vascular anomalies is vital for medium and long-term blood pressure control.
Amar
Jacques
J
Service de Médecine Interne et d'Hypertension artérielle, INSERM 558, Toulouse, France.
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D048909:Diabetes Complications / Q000188:drug therapy* / Q000503:physiopathology; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D012307:Risk Factors
D000959:Antihypertensive Agents