New perspectives in diagnosis and treatment of resistant. Resistant hypertension is blood pressure above goal despite adherence to a combination of at least three antihypertensive medications of different classes, optimally dosed and usually includ ing. Diagnosis and management of resistant hypertension. Resistant hypertension is generally defined as uncontrolled clinic blood pressure 14090 mm hg after treatment with three or more antihypertensives.
Treatment of resistant and refractory hypertension circulation. One common cause of pseudoresistant hypertension is the whitecoat effect. Apr 01, 2017 understanding potential causes of resistant hypertension false resistance. The two main interventional approaches, transcatheter renal denervation and baroreflex activation therapy, are used in clinical practice for severe treatment resistant hypertension in some countries. The diagnosis of resistant hypertension requires use of good blood pressure technique to confirm persistently elevated blood pressure levels. Bisognano, md phd professor of medicine cardiology president. Resistant hypertension rh is defined by a failure to achieve goal blood pressure bp despite appropriate adherence to a three antihypertensive drug regimen 1. Apr 02, 20 this masters in medicine webcast is one in a threepart series by dr. Resistant hypertension has several possible causes, including another underlying medical condition. Although the exact prevalence of resistant hypertension is currently unknown, indirect evidence from population studies and clinical trials suggests that it is a relatively common clinical problem. Resistant hypertension is defined as uncontrolled blood pressure despite the use of three antihypertensive drugs, including a diuretic, in optimal doses. May 15, 2009 evaluation and management of the patient with difficulttocontrol or resistant hypertension anthony j. Recent studies indicate that primary aldosteronism is a much more common cause of hypertension than previously reported, and it is present in about 20% of patients with resistant hypertension, the.
As defined, resistant hypertension includes patients whose blood pressure is controlled with use of more than 3 medications. Resistant hypertension needs special attention harvard health. Patients whose blood pressure is controlled with four or more medications are considered to have resistant hypertension. Resistant hypertension rhtn is an increasingly common clinical problem1,2 that almost always has multiple etiologies, risk factors, and comorbidities. Moreover, in order to achieve similar blood pressure control, kidney transplant recipients without a family history of hypertension. A variety of drugs are available to treat high blood pressure. Ideally, one of the 3 agents should be a diuretic and all agents should be prescribed at optimal dose amounts. Management of hypertension 2015 georgia chapter acp scientific meeting john j.
Lowdose spironolactone in resistant hypertension 2410282512221022930252015105 0 ouzan 2002 mahmud 2005. Some people with resistant hypertension have overactive adrenal glands. Resistant hypertension is defined as blood pressure above the patients goal despite the use of 3 or more antihypertensive agents from different classes at optimal doses, one of which should ideally be a diuretic. Resistant hypertension workup and approach to treatment. Evaluation of resistant hypertension in clinical practice matthew r. Recent evidence, although limited, suggests that trh may also adversely affect healthrelated quality of life hrqol and other patientreported outcomes. Nov 05, 2015 treatment resistant hypertension trh is defined by office blood pressure bp uncontrolled on. Define resistant hypertension recognize the role of history and physical examination in identifying secondary causes evaluate the best lifestyle and pharmacological treatment for resistant hypertension future therapies. Resistant hypertension is defined by the seventh joint national committee jnc 7 as the inability to achieve a blood pressure lower than 14090 mm hg despite optimal doses of 3 or more antihypertensive drugs, including 1 diuretic.
Treatment resistance can be attributed to poor adherence to antihypertensive drugs, excessive salt intake, physician inertia, inappropriate or inadequate medication, and secondary hypertension. Recommendations for the management of patients with resistant hypertension. Apparent atrh is used when optimal therapy, adherence, and measurement artifacts are unknown. A diagnosis of true resistant hypertension should be made only after a thorough assessment to exclude apparent or pseudo resistant hypertension. Resistant hypertension is defined as blood pressure that remains above goal in spite of concurrent use of 3 antihypertensive agents of different classes.
While the exact prevalence of resistant hypertension is unknown, clinical trials suggest that it is not rare, involving perhaps 20% to 30% of study participants. Up to onethird of people who were thought to have treatmentresistant high blood pressure may actually have white coat hypertension blood pressure that spikes in the doctors office. Common secondary causes of resistant hypertension and. Nov 20, 2012 resistant hypertension is defined as high blood pressure that remains uncontrolled despite treatment with at least three antihypertensive agents one of which is usually a diuretic at best tolerated doses. Although the definition of resistant hypertension is arbitrary relative to the number of antihypertensive medications required, the concept of resistant hypertension is focused on identifying patients who are at high risk of having reversible causes of hypertension andor patients who, because of persistently high bp levels, may benefit from. Resistant hypertension is defined as hypertension that is poorly responsive to treatment and requires. This is a scenario where the patient never actually has high blood pressure and only appears to have it in a clinical. New guidelines for resistant hypertension from the aha. Nationally recognized expertise in treating resistant hypertension and minimizing the harm it causes. Evaluation of patients with resistive hypertension should first confirm that they have true resistant hypertension by ruling out or correcting factors associated with. However, the precise mechanisms for this link remain. Diuretics lower blood pressure by helping your kidneys get rid of extra salt and water in your body.
Mar 28, 2011 up to onethird of people who were thought to have treatmentresistant high blood pressure may actually have white coat hypertension blood pressure that spikes in the doctors office. Emerging evidence suggests that multiple mechanisms may be responsible for the development of treatment resistant hypertension trh. Pseudoresistance, including lack of blood pressure control secondary to poor medication adherence or white coat hypertension, must be excluded. The jnc 7 guidelines were a comprehensive expert consen sus of the prevention, detection, evaluation, and treatment of high blood pressure in adults chobanian 2003, whereas the. Elect, american society of hypertension director, outpatient cardiology university of rochester resistant hypertension blood pressure not controlled on three anti. Because of the increasing prevalence of rhtn and its association with increased cardiovascular risk, there has been a growing interest in its epidemiology, pathophysiology, and effective treatment. Pdf hypertension resistant to lifestyle interventions and antihypertensive medications is a common problem encountered by physicians in everyday. This is a scenario where the patient never actually has high blood pressure and only appears to have it. Evaluation of resistant hypertension in clinical practice. Resistant hypertension is found in up to 30% of patients with hypertension and is defined as sustained high blood pressure despite treatment with 3 or more antihypertensive drugs including a diuretic.
Hypertension if not treated can lead to many serious. Its the norm for people with resistant hypertension to see their blood pressure drop precipitously while at pritikin, and often within one to two weeks, states dr. Adequate treatment of hypertension is an important but vexed issue in nephrology. Characterization and treatment of resistant hypertension. Resistant hypertension rh is defined as abovegoal elevated blood pressure bp in a patient despite the concurrent use of 3 antihypertensive drug classes, commonly including a longacting calcium channel blocker, a blocker of the reninangiotensin system angiotensinconverting enzyme inhibitor or angiotensin receptor blocker, and a diuretic. Excess sodium and fluid retention, increased activation of the reninangiotensinaldosterone. Resistant hypertension is almost always multifactorial in. What is new in the management of resistant hypertension.
The pritikin program whats important to point out is that frank is hardly alone. Hypertension is usually defined as resistant or refractory when a therapeutic plan that includes consideration of lifestyle methods and a prescription of at least three different drugs including a diuretic in optimal doses has failed to diminish both systolic and diastolic blood pressure bp to threshold. Understanding potential causes of resistant hypertension false resistance. Jun 27, 2015 treatment resistant hypertension trh is an increasingly common and clinically challenging hypertension phenotype associated with adverse impact on cardiovascular events and death. Hinderliter, md, university of north carolina at chapel hill. Prevalence of resistant hypertension is increasing. Resistant hypertension is defined as blood pressure that remains above goal in spite of the concurrent use of 3 antihypertensive agents of different classes. Resistant hypertension is defined as blood pressure that remains above goal despite concurrent use of three antihypertensive agents of different classes, one of which should be a diuretic. Define resistant hypertension recognize the role of history and physical examination in identifying secondary causes evaluate the best lifestyle and pharmacological.
As defined, resistant hypertension includes patients whose blood. If you have resistant hypertension, its worth being checked for what doctors call a secondary cause. Resistant hypertension has several possible causes mayo. Evaluation and management of the patient with difficulttocontrol or resistant hypertension anthony j. Renal denervation is also being evaluated for treatment of various comorbidities, eg, chronic heart failure, cardiac arrhythmias and chronic renal. The commonest reasons for apparent treatment resistance are medication noncompliance and insufficient drug therapy. Quality of life in treatmentresistant hypertension. Diagnosis and management of resistant hypertension heart.
Weir, md professor and director division of nephrology university of maryland school of medicine. Electrical stimulation of the carotid sinus is a new interesting approach for the treatment of resistant hypertension. Precise diagnosis to identify the type and root causes of your hypertension, including advanced home monitoring devices to track your blood pressure over a longer period of time. New approaches in the treatment of hypertension circulation. This masters in medicine webcast is one in a threepart series by dr. A commonly overlooked source of high blood pressure is the breathholding type of snoring known as obstructive sleep apnea. Resistant hypertension advances in chronic kidney disease.
Resistant hypertension is defined as failure to achieve goal blood pressure bp when a patient adheres to the maximum tolerated doses of 3 antihypertensive drugs including a diuretic. Resistant hypertension is seen more frequently in patients. Moreover, subjects with resistant hypertension had a higher prevalence of diabetes as. Compared with data from the general population or hypertensive individuals, a higher frequency of resistant hypertension rh has been observed in subjects with type 2 diabetes. Pdf diagnosis and treatment of resistant hypertension. Hypertension is widely encountered in family medicine. Resistant hypertension high blood pressure thats hard. Resistant hypertension is a common clinical problem faced by both primary care clinicians and specialists. Management of patients with resistant hypertension. Pdf resistant hypertension rh is defined as failure to achieve goal blood pressure while receiving a 3 drug regimen at optimal doses that includes a. Epidemiology, pathophysiology, diagnosis and treatment for online ebook. Resistant hypertension is defined as blood pressure above the patients goal despite the use of 3 or more antihypertensive agents from different classes at optimal doses, one of which should. Despite improvements in hypertension awareness and treatment, 30%60% of. Resistant hypertension may have one or more other underlying medical conditions.
Causes of resistant hypertension stanford health care. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. Evaluation and management of the patient with difficultto. Hypertension is a global problem that contributes substantially to morbidity, mortality, and healthcare costs. Treatment resistant hypertension trh is defined by office blood pressure bp uncontrolled on. Epidemiology, pathophysiology, diagnosis and treatment free pdf d0wnl0ad, audio books, books to read, good books to read, cheap books, good books, online books, books online, book. Despite its prevalence, many patients have uncontrolled or difficulttocontrol blood pressure. Recognition and management of resistant hypertension american. Pdf resistant hypertension workup and approach to treatment.
921 485 96 435 536 767 340 75 1074 1139 1121 581 193 253 1000 125 500 1341 1418 621 1268 866 240 658 208 722 1008 1457 466 151 276 174 991 79 1264 1365 883 1371 782 110 165 1389 377 541 624