Diagnosis and treatment of resistant hypertension.
Hypertension resistant to lifestyle interventions and antihypertensive medications is a common problem encountered by physicians in everyday practice. It is most often defined as a blood pressure remaining ≥ 140/90 mmHg despite the regular intake of at least three drugs lowering blood pressure by different mechanisms, one of them being a diuretic. It now appears justified to include, unless contraindicated or not tolerated, a blocker of the renin-angiotensin system and a calcium channel blocker in this drug regimen, not only to gain antihypertensive efficacy, but also to prevent or regress target organ damage and delay the development of cardiorenal complications. A non-negligible fraction of treatment-resistant hypertension have normal "out of office" blood pressures. Ambulatory blood pressure monitoring and/or home blood pressure recording should therefore be routinely performed to identify patients with true resistant hypertension, i.e. patients who are more likely to benefit from treatment intensification.
Division of Pathophysiology, Centre Hospitalier Universitaire Vaudois and University of Lausanne , Lausanne , Switzerland.
Bernard
B
Waeber
Massimo
M
Volpe
Luis M
LM
Ruilope
Roland E
RE
Schmieder
D000959:Antihypertensive Agents / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged
D000959:Antihypertensive Agents
Ambulatory blood pressure monitoring; combination therapy (antihypertensive medications); diuretic therapy; hypertension guidelines (hypertension); refractory hypertension; renin–angiotensin–aldosterone system; self-measurement of blood pressure