title: [Management of resistant hypertension].
abstract: High blood pressure is one of the leading factors influencing the cardiovascular risk. Despite current knowledge on the management of hypertension and the numerous antihypertensive drugs available, hypertension remains insufficiently controlled and part of these "uncontrolled" patients meet the definition of resistant hypertension. Resistant hypertension is defined by the failure of lowering blood pressure values to blood pressure target (office blood pressure < 140/90 or 130/80 mmHg in patients with diabetes or chronic kidney disease) despite appropriate treatment with optimal doses of three antihypertensive drugs from three different classes, one of which is a diuretic. Pseudoresistance should be excluded by using 24h ambulatory blood pressure or home blood pressure. The management of resistant hypertension includes the screening of secondary forms of hypertension and the identification of life style factors such as obesity, excessive alcohol and dietary sodium intake, volume overload, drug-induced hypertension. The treatment associates lifestyle changes, discontinuation of interfering substances, association of antihypertensive drugs on top of the initial triple therapy (including diuretic, blockers of the renin-angiotensin system and calcium channel blockers) ie aldosterone antagonists as fourth line treatment. New device-based approaches aiming to decrease the sympathetic tone including renal denervation and baroreceptor stimulation are under development.
authors.affiliation: Université Paris-Descartes, Inserm, Centre d'investigation clinique 9201, Hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France. marie.briet@egp.aphp.fr
authors.forename: Marie
authors.initials: M
authors.lastname: Briet
authors.forename: Guillaume
authors.initials: G
authors.lastname: Bobrie
authors.forename: Michel
authors.initials: M
authors.lastname: Azizi
mesh_terms: D000465:Algorithms; D050034:Antidiuretic Agents / Q000008:administration & dosage; D000959:Antihypertensive Agents / Q000008:administration & dosage; D004351:Drug Resistance; D006801:Humans; D006974:Hypertension, Malignant / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D010353:Patient Education as Topic; D012307:Risk Factors
chemical_list: D050034:Antidiuretic Agents; D000959:Antihypertensive Agents