Challenging hypertension: how to diagnose and treat resistant hypertension in daily clinical practice.
Arterial hypertension is a very complex disease characterized by a sustained rise in systolic and/or diastolic blood pressure (BP) levels and a significantly increased risk of developing major adverse cardiovascular and renal outcomes. Although BP-lowering treatment reduces the hypertension-related burden of disease, BP control continues to be poorly achieved worldwide. A major factor contributing to this therapeutic failure is represented by resistant (or refractory) hypertension. The diagnosis of 'resistant hypertension' is very common in clinical practice, yet it is often used to improperly define patients with difficult or challenging forms of hypertension. An incorrect use of this definition by physicians may lead to clinical behaviors that do not help to improve BP control; on the other hand, correct diagnosis of resistant hypertension may facilitate the successful treatment of hypertension. In this article, we will review and discuss the definition, pathophysiological mechanisms, diagnostic algorithms and potential new therapeutic options for treating resistant hypertension.
Volpe
Massimo
M
Division of Cardiology, II Faculty of Medicine, University of Rome La Sapienza, Sant'Andrea Hospital, Via di Grottarossa, 1035-9, 00189 Rome, Italy. massimo.volpe@uniroma1.it
Tocci
Giuliano
G
D000959:Antihypertensive Agents / Q000145:classification / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D006801:Humans; D006973:Hypertension / Q000139:chemically induced / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D017410:Practice Guidelines as Topic; D051437:Renal Insufficiency / Q000209:etiology / Q000517:prevention & control; D012084:Renin-Angiotensin System / Q000187:drug effects / Q000502:physiology; D013564:Sympathetic Nervous System / Q000187:drug effects / Q000503:physiopathology; D016896:Treatment Outcome
D000959:Antihypertensive Agents