title: [Management of resistant hypertension. Expert consensus statement from the French Society of Hypertension, an affiliate of the French Society of Cardiology].
abstract: To improve the management of resistant hypertension, the French Society of Hypertension, an affiliate of the French Society of Cardiology, has published a set of eleven recommendations. The primary objective is to provide the most up-to-date information, based on the strongest scientific rationale and which is easily applicable to daily clinical practice for health professionals working within the French health system. Resistant hypertension is defined as uncontrolled blood pressure (BP) both on office measurements and confirmed by out-of-office measurements despite a therapeutic strategy comprising appropriate lifestyle and dietary measures and the concurrent use of three antihypertensive agents including a thiazide diuretic, a renin-angiotensin system blocker (ARB or ACEI) and a calcium channel blocker, for at least four weeks, at optimal doses. Treatment compliance must be closely monitored, as most factors that are likely to affect treatment resistance (excessive dietary salt intake, alcohol, depression and drug interactions, or vasopressors). If the diagnosis of resistant hypertension is confirmed, the patient should be referred to a hypertension specialist to screen for potential target organ damage and secondary causes of hypertension. The recommended treatment regimen is a combination therapy comprising four treatment classes, including spironolactone (12.5 to 25mg/day). In the event of a contraindication or a non-response to spironolactone, or if adverse effects occur, a β-blocker, an α-blocker, or a centrally acting antihypertensive drug should be prescribed. Because renal denervation is still undergoing assessment for the treatment of hypertension, this technique should only be prescribed by a specialist hypertension clinic.
authors.affiliation: Société française d'hypertension artérielle, 75012 Paris, France. Electronic address: denolle.thierry@wanadoo.fr.
authors.forename: Thierry
authors.initials: T
authors.lastname: Denolle
authors.affiliation: Société française d'hypertension artérielle, 75012 Paris, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Chamontin
authors.affiliation: Société française d'hypertension artérielle, 75012 Paris, France.
authors.forename: Gérard
authors.initials: G
authors.lastname: Doll
authors.affiliation: Société française d'hypertension artérielle, 75012 Paris, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Fauvel
authors.affiliation: Société française d'hypertension artérielle, 75012 Paris, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Girerd
authors.affiliation: Société française d'hypertension artérielle, 75012 Paris, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Herpin
authors.affiliation: Société française d'hypertension artérielle, 75012 Paris, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Vaïsse
authors.affiliation: Société française d'hypertension artérielle, 75012 Paris, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Villeneuve
authors.affiliation: Société française d'hypertension artérielle, 75012 Paris, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Halimi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D004039:Diet, Sodium-Restricted; D004347:Drug Interactions; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D005602:France; D058006:General Practice; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D033183:Interdisciplinary Communication; D008019:Life Style; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D012017:Referral and Consultation; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D049993:Sodium Chloride Symporter Inhibitors