title: Reduction of blood pressure in patients with treatment-resistant hypertension.
abstract: BACKGROUND
  Resistant hypertension is a common clinical problem, and patients with resistant hypertension have increased cardiovascular risk. It is a subset of the hypertensive population that is little studied and poorly characterized.
  
  
  OBJECTIVE
  The purpose of this review is to discuss resistant hypertension, its recognition and diagnostic workup and management, and to present current data about the disease from the latest research.
  
  
  METHODS
  We define resistant hypertension and differentiate it from pseudoresistance. We identify diagnostic tests that may be done on patients with resistant hypertension. Last, we discuss therapeutic approaches to resistant hypertension, focusing on pharmacological treatment, and present an algorithm that may be used by the clinician in treating a patient with resistant hypertension.
  
  
  CONCLUSIONS
  Resistant hypertension is a significant clinical problem commonly encountered by clinicians. Patients with resistant hypertension have increased cardiovascular risk. In evaluating for resistant hypertension, it is important to recognize elements that contribute to pseudoresistance to treatment. Secondary causes of hypertension are common in patients with resistant hypertension and should be included in the diagnostic workup. Pharmacological treatment for resistant hypertension entails choosing medications with complementary mechanisms of action, optimizing diuretic use, and considering the use of mineralocorticoid antagonists as an add-on agent to the antihypertensive regimen.
authors.affiliation: University of Alabama at Birmingham, 35294-2041, USA. czarina.acelajado@ccc.uab.edu
authors.forename: Maria Czarina
authors.initials: MC
authors.lastname: Acelajado
authors.forename: David A
authors.initials: DA
authors.lastname: Calhoun
authors.forename: Suzanne
authors.initials: S
authors.lastname: Oparil
mesh_terms: D000465:Algorithms; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D004351:Drug Resistance; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000959:Antihypertensive Agents