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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 2017 Sep 05

DOI: 10.23736/S0026-4725.17.04495-4


language: English

Resistant hypertension: an overview

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

1 Dipartimento di Patologia Chirurgica, Medica, Molecolare e dell'Area Critica, Università di Pisa, Pisa, Italy; 2 Dipartimento di Medicina, Sezione di Cardiologia e Fisiopatologia Cardiovascolare, Università di Perugia, Perugia, Italy; 3 Dipartimento di Biotecnologie Mediche, Cardiologia Universitaria, Università di Siena, Siena, Italy; 4 Dipartimento di Neuroscienze, Area del Farmaco e Salute del Bambino (NEUROFARBA), Università di Firenze, Firenze, Italy; 5 Fondazione Toscana G. Monasterio, Istituto di Fisiologia Clinica, CNR, Pisa, Italy; 6 Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze, Firenze, Italy; 7 Dipartimento di Medicina Interna, UOS Malattie Cardiovascolari, Università di Siena, Siena, Italy; 8 IRCCS Multimedica, Milano, Italy


Despite the availability of anti-hypertensive medications with proven efficacy and good tolerability, many hypertensive patients have blood pressure levels(BP) 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, despite adequate treatment, 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. Although several studies have approached the issue of the prevalence of RH in the hypertensive population, its prevalence is by and large based upon reasonable but approximate estimates for reasons detailed in the text. Standardized combination therapy based upon angiotensin converting enzyme inhibitors or angiotensin receptor blockers, amlodipine or other dihydropiridine calcium channel blockers and a diuretic (thiazide and thiazide-like compounds as cholrthalidone or indapamide) has been advocated to treat RH with spironolactone as fourth add-on drug. Interventional procedures such as renal denervation have been devised to treat RH and implemented in some patients with RH not responding to medical treatment. However, the results of this interventional procedure have insofar not been positive. 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 and increased cardio- and cerebrovascular risk and deserves, therefore, particular care.

KEY WORDS: Hypertension - Resistance to antihypertensive drugs - Cardiovascular risk

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Publication History

Article first published online: September 05, 2017
Manuscript accepted: August 30, 2017
Manuscript received: August 7, 2017

Cite this article as

Pedrinelli R, Ambrosio G, Cameli M, Cerbai E, Coiro S et al; Società Italiana di Cardiologia, Sezione Regionale Tosco-Umbra. Resistant hypertension: an overview. Minerva Cardioangiol 2017 Sep 05. DOI: 10.23736/S0026-4725.17.04495-4

Società Italiana di Cardiologia, Sezione Regionale Tosco-Umbra

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