Resistant hypertension: medical management and alternative therapies

Cardiol Clin. 2015 Feb;33(1):75-87. doi: 10.1016/j.ccl.2014.09.003.

Abstract

Resistant hypertension affects 20% to 30% of patients with high blood pressure (BP). It is defined as failure to achieve goal BP despite using at least 3 antihypertensive drugs of different classes, at maximal tolerated doses, one of which must be a diuretic. Persistent suboptimal BP is the most common attributable risk for death worldwide and its prevalence will most likely increase over the next decade. We review the epidemiologic aspects and diagnostic challenges of resistant hypertension, barriers to achieving proper BP control, and causes of secondary hypertension. Lifestyle modification and pharmacologic and device approaches to treatment are discussed.

Keywords: Device; Hypertension; Joint National Committee; Resistant hypertension; Secondary hypertension.

Publication types

  • Review

MeSH terms

  • Aged
  • Antihypertensive Agents / adverse effects
  • Antihypertensive Agents / therapeutic use*
  • Cooperative Behavior
  • Coronary Vasospasm / diagnosis
  • Coronary Vasospasm / epidemiology
  • Coronary Vasospasm / etiology
  • Coronary Vasospasm / therapy*
  • Cross-Sectional Studies
  • Diuretics / therapeutic use
  • Dose-Response Relationship, Drug
  • Drug Therapy, Combination
  • Electric Stimulation Therapy / methods*
  • Female
  • Humans
  • Hypertension / diagnosis
  • Hypertension / epidemiology
  • Hypertension / etiology
  • Hypertension / therapy*
  • Interdisciplinary Communication
  • Kidney / innervation*
  • Life Style*
  • Male
  • Medication Adherence
  • Middle Aged
  • Pressoreceptors / physiopathology
  • Prognosis
  • Sympathectomy / methods*

Substances

  • Antihypertensive Agents
  • Diuretics

Supplementary concepts

  • Hypertension Resistant to Conventional Therapy