title: Treatment resistant hypertension--investigation and conservative management.
abstract: BACKGROUND
  The introduction of invasive treatments, some of which are irreversible, for the entity called treatment-resistant hypertension (TRH) creates the need for a comprehensive discussion of the diagnostic evaluation that TRH requires and the available options for its conservative treatment.
  
  
  METHODS
  The pertinent literature is selectively reviewed in the light of the authors' longstanding clinical experience.
  
  
  RESULTS
  Our review of the literature suggests that the high prevalence of TRH in Germany (ca. 20%) can be nearly halved with the aid of more thorough diagnostic evaluation. Such an evaluation should include a review of the patient's antihypertensive drugs (adherence, daily dosing, concomitant medication), investigation for other vascular changes that might affect blood pressure measurement, and exclusion of white-coat hypertension, sleep apnea syndrome, and secondary rather than essential hypertension. As there have been no randomized trials of treatment for TRH, the physician confronted with such cases must devise treatments on the basis of observational data and pathophysiological reasoning (volume status considering renin levels, sympathetic blockade, vasodilatation). Such measures can presumably lower the number of truly treatment-resistant cases still further.
  
  
  CONCLUSIONS
  To save patients from preventable harm, patients should undergo a thorough diagnostic evaluation and-under close monitoring for side effects-conservative pharmacological and nonpharmacological treatments should be deployed before any invasive treatment is performed.
authors.affiliation: St Walburga Hospital, Meschede, Private Practice at the Medical Care Center, Dialysis Center, Cuxhaven.
authors.forename: Franz
authors.initials: F
authors.lastname: Weber
authors.forename: Manfred
authors.initials: M
authors.lastname: Anlauf
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D002908:Chronic Disease; D004232:Diuretics / Q000627:therapeutic use*; D004351:Drug Resistance; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy*; D015995:Prevalence
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics