A guide for easy- and difficult-to-treat hypertension.
Although the blood pressure (BP) of many patients can be controlled using standard combinations, treatment of hypertension frequently represents a clinical challenge to the primary care physician. This article will review best practices for managing patients with easy- and difficult-to-treat hypertension, including preferred antihypertensive combinations, optimizing adherence and persistence, recognizing white-coat hypertension, and intensifying therapy for treatment-resistant patients. Each physician must decide based on his or her own level of experience at what point a patient becomes too challenging and would benefit from referral to a hypertension specialist for more intensive management and to complete the exclusion of secondary forms of arterial hypertension. With intensive pharmacotherapy, many patients with difficult-to-treat hypertension can achieve BP control. If it fails, interventional strategies (e.g., renal denervation) are a valid option to get BP controlled.
Department of Nephrology and Hypertension, University Hospital Erlangen, Germany. Electronic address: roland.schmieder@uk-erlangen.de.
Roland E
RE
Schmieder
Cardiology Unit, Clinical and Molecular Medicine Department Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, Italy.
Massimo
M
Volpe
Centre Hôpitalier des Univérsités Vaudois (CHUV), Division de physiopathologie clinique, Lausanne, Switzerland.
Bernard
B
Waeber
Hypertension Unit, Hospital 12 de Octubre, & Department of Public Health and Preventive Medicine, Universidad Autónoma, Madrid, Spain.
Luis M
LM
Ruilope
D000465:Algorithms; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D006801:Humans; D006977:Hypertension, Renal / Q000188:drug therapy* / Q000601:surgery*; D013562:Sympathectomy / Q000379:methods*
D000959:Antihypertensive Agents
Hypertension; Renal denervation; Treatment algorithm