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A Journal on Heart and Vascular Diseases

Official Journal of the Italian Society of Angiology and Vascular Pathology
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Minerva Cardioangiologica 2009 December;57(6):787-811

language: English

Treatment of resistant hypertension

Czarina Acelajado M., Calhoun D. A.

Department of Cardiology and Angiology, Medical School of Hannover, Hannover, Germany


Background: Resistant hypertension is a common clinical problem. Patients with resistant hypertension have increased cardiovascular risk. These patients also have an increased likelihood of having reversible causes of hypertension. Accurate diagnosis of resistant hypertension is essential as such patient may potentially benefit from special diagnostic or therapeutic considerations.
Objective: The purpose of this review is to discuss resistant hypertension, its definition, recognition, evaluation, and treatment.
Methods: We discuss the definition of resistant hypertension as suggested recently by the American Heart Association and the clinical implications of this definition. We present current data on its prevalence, prognostic implications, genetics, and patient characteristics. Elements of pseudoresistance and possible etiologies of treatment resistance are identified. Lastly, we discuss diagnostic and therapeutic approaches to resistant hypertension. We focus on antihypertensive medication classes that have proven benefit in patients with resistant hypertension, and also discuss emerging therapeutic approaches for these patients.
Conclusion: Resistant hypertension is a common clinical problem and carries an increased risk for cardiovascular morbidity and mortality as well as target organ damage. Patients with resistant hypertension are at high risk for reversible causes of hypertension and may benefit from special diagnostic or therapeutic considerations. Elements of pseudoresistance, intake of interfering substances and secondary causes of hypertension should be searched for and corrected, if possible. Therapeutic lifestyle modifications should be emphasized. Medical therapy includes optimizing diuretic therapy including use of mineralocorticoid antagonists as add on antihypertensive agents. Potentially novel approaches for resistant hypertension include surgical and transcatheter techniques, chronotherapy, and new classes of antihypertensive agents.

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