Mechanisms and treatment of resistant hypertension.
Resistant hypertension is defined as blood pressure (BP) that remains uncontrolled in spite of the use of >/=3 antihypertensive medications. Stricter BP goals, higher obesity rates, older age, and increased use of exogenous BP-elevating substances are related to an increasing prevalence of resistant hypertension. The evaluation of patients with resistant hypertension is focused on identifying contributing and secondary causes of hypertension, including hyperaldosteronism, obstructive sleep apnea, chronic kidney disease, renal artery stenosis, and pheochromocytoma. Hyperaldosteronism is now recognized as the most common cause of resistant hypertension, and all patients with resistant hypertension should be screened with a plasma aldosterone/renin ratio even if the serum potassium level is normal. Treatment includes removal of contributing factors, appropriate management of secondary causes, and use of effective multidrug regimens. Recent studies indicate that the addition of spironolactone to standard treatment induces significant BP reduction in most patients with resistant hypertension.
Pimenta
Eduardo
E
Vascular Biology and Hypertension Program, University of Alabama at Birmingham, 933 19th Street South, Birmingham, AL 35294, USA. eduardo.pimenta@ccc.uab.edu
Gaddam
Krishna K
KK
Oparil
Suzanne
S
D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015897:Comorbidity; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology; D000451:Mineralocorticoid Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D012307:Risk Factors; D013148:Spironolactone / Q000009:adverse effects / Q000627:therapeutic use
D000959:Antihypertensive Agents; D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone