Characterization and treatment of resistant hypertension.
Resistant hypertension is a common medical problem. It carries a significantly increased risk of end-organ damage and cardiovascular events compared with more easily controlled hypertension. Resistant hypertension is most often related to isolated systolic hypertension and is characterized by aldosterone excess and increased intravascular volume. Its diagnosis requires the exclusion of pseudoresistance. The etiology of resistant hypertension is almost always multifactorial. Common reversible contributing factors need to be identified and addressed. Secondary causes of hypertension, such as primary aldosteronism, parenchymal and vascular kidney disease, and obstructive sleep apnea, require investigation and effective treatment if present. Therapy for resistant hypertension should be based on use of rational drug class combinations at optimal doses, with particular attention to adequate diuretic use. The addition of an aldosterone antagonist may further improve blood pressure control.
Pisoni
Roberto
R
Vascular Biology and Hypertension Program, University of Alabama at Birmingham, 115 Community Health Services Building, 933 19th Street South, Birmingham, AL 35294, USA. pisoni@uab.edu
Ahmed
Mustafa I
MI
Calhoun
David A
DA
D000310:Adrenal Gland Neoplasms / Q000150:complications; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D004351:Drug Resistance; D006801:Humans; D006929:Hyperaldosteronism / Q000150:complications; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000150:complications; D008019:Life Style; D009765:Obesity / Q000150:complications; D010673:Pheochromocytoma / Q000150:complications; D047748:Pituitary ACTH Hypersecretion / Q000150:complications; D015995:Prevalence; D011379:Prognosis; D012078:Renal Artery Obstruction / Q000150:complications; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications; D017211:Treatment Failure; D014481:United States / Q000453:epidemiology
D000959:Antihypertensive Agents