Resistant hypertension: identifying causes and optimizing treatment regimens.
Management of resistant hypertension (RH), defined as uncontrolled blood pressure on three or more antihypertensive medications including a diuretic, begins initially with identifying and addressing contributors such as medication adherence, lifestyle factors and the use of interfering substances. Evaluation for the "white-coat" phenomenon, or associated conditions and secondary causes such as sleep apnea, primary aldosteronism, chronic kidney disease or renovascular disease may be indicated. Inadequate dosing, lack of using long-acting diuretics, and suboptimal combinations are observed as causes in nearly half of patients with RH. Appropriate pharmacotherapy of RH begins first with insuring the patient is receiving appropriate therapy for compelling indications, as outlined by the JNC-7 guidelines. Specific regimen enhancements to achieve blood pressure control include the addition of aldosterone antagonists, dual renin-angiotensin system blockade, and dual calcium channel blockade. Addition of centrally acting agents, alpha blockers, or vasodilators may also be necessary.
Trewet
Cora Lynn B
CL
Division of Clinical and Administrative Pharmacy, College of Pharmacy, The University of Iowa, Iowa City, Iowa, USA.
Ernst
Michael E
ME
D000465:Algorithms; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D004232:Diuretics / Q000627:therapeutic use; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008019:Life Style; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D010349:Patient Compliance; D017211:Treatment Failure
D000959:Antihypertensive Agents; D004232:Diuretics; D000451:Mineralocorticoid Receptor Antagonists