Resistant hypertension: who and how to evaluate.
OBJECTIVE
Resistant hypertension is found in an important and rapidly growing subset of the hypertensive population, and data characterizing this group of patients are limited. The purpose of this review is to present the latest evidence on resistant hypertension, its risk factors, patient characteristics, and approach to diagnosis. We focus on important associations between resistant hypertension and primary aldosteronism and with obstructive sleep apnea.


RESULTS
Resistant hypertension comprises 20-35% of the general hypertensive population. It is important to ascertain that a patient has true resistant hypertension and not merely uncontrolled hypertension. Twenty-four-hour ambulatory blood pressure monitoring can reliably rule out a white-coat effect and may have prognostic significance in patients with resistant hypertension. Patients should be screened for secondary causes of hypertension. Primary aldosteronism is common among patients with resistant hypertension, as is obstructive sleep apnea. A plasma aldosterone to renin ratio is a useful screening tool for primary aldosteronism. Aldosterone has been found to accelerate the increase in left ventricular mass in patients with hypertension.


CONCLUSIONS
Patients with resistant hypertension comprise a unique subset, with risk factors and associations that are distinct or pronounced compared with the general hypertensive population. It is important to bear these associations in mind when dealing with patients with true resistant hypertension.
Acelajado
Maria Czarina
MC
Vascular Biology and Hypertension Program, University of Alabama at Birmingham, Birmingham, Alabama 35294-2041, USA. czarina.acelajado@ccc.uab.edu
Calhoun
David A
DA
D000450:Aldosterone; D000959:Antihypertensive Agents / Q000627:therapeutic use; D018660:Blood Pressure Monitoring, Ambulatory; D006801:Humans; D006929:Hyperaldosteronism; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy*; D011379:Prognosis; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive; D017211:Treatment Failure
D000959:Antihypertensive Agents; D000450:Aldosterone