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Minerva Cardioangiologica 2018 June;66(3):337-48

DOI: 10.23736/S0026-4725.17.04495-4

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Resistant hypertension: an overview

Roberto PEDRINELLI 1 , Giulia DELL’OMO 1, Matteo CAMELI 2, Elisabetta CERBAI 3, Stefano COIRO 4, Michele EMDIN 5, Riccardo LIGA 1, Rossella MARCUCCI 6, Doralisa MORRONE 1, Alberto PALAZZUOLI 7, Ketty SAVINO 4, Luigi PADELETTI 6, 8, Giuseppe AMBROSIO 4, on behalf of Società Italiana di Cardiologia, Sezione Regionale Tosco-Umbra

1 Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy; 2 Department of Medical Biotechnology, University Cardiology, University of Siena, Siena, Italy; 3 Department of Neurosciences, Area del Farmaco e Salute del Bambino (NEUROFARBA), University of Florence, Florence, Italy; 4 Section of Cardiology and Cardiovascular Pathophysiology, Department of Medicine, University of Perugia, Perugia, Italy; 5 Fondazione Toscana G. Monasterio, Institute of Clinical Physiology, CNR, Pisa, Italy; 6 Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; 7 Department of Internal Medicine, UOS Malattie Cardiovascolari, University of Siena, Siena, Italy; 8 IRCCS Multimedica, Milan, Italy


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Despite the availability of anti-hypertensive medications with proven efficacy and good tolerability, many hypertensive patients have blood pressure (BP) levels not at the goals set by international societies. Some of these patients are either non-adherent to the prescribed drugs or not optimally treated. However, a proportion has resistant hypertension (RH) defined as office BP above goal despite the use of ≥3 antihypertensive medications at maximally tolerated doses (one ideally being a diuretic). Diagnosis of RH based upon office measurements, however, needs confirmation through 24-h BP monitoring to exclude “white coat” RH since cardiovascular events and mortality rates follow mean ambulatory BPs. Standardized combination therapy based upon angiotensin converting enzyme inhibitors or angiotensin receptor blockers, amlodipine or other dihydropiridine calcium channel blockers and thiazide or thiazide-like diuretics has been advocated to treat RH with spironolactone as preferred fourth add-on drug. Interventional procedures such as renal denervation have been devised to treat RH and tested with insofar not positive results in series of patients not responding to medical treatment. It is unclear whether RH constitutes a specific phenotype of EH or should rather be considered a more serious form of uncontrolled hypertension. Whatever the case, its presence associates with an increased cardio- and cerebrovascular risk and deserves, therefore, particular care.


KEY WORDS: Hypertension - Capillary resistance - Antihypertensive agents

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