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Int J Cardiol. 2014 Mar 1;172(1):17-22. doi: 10.1016/j.ijcard.2013.12.125. Epub 2014 Jan 4.

A guide for easy- and difficult-to-treat hypertension.

Author information

1
Department of Nephrology and Hypertension, University Hospital Erlangen, Germany. Electronic address: roland.schmieder@uk-erlangen.de.
2
Cardiology Unit, Clinical and Molecular Medicine Department Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, Italy.
3
Centre Hôpitalier des Univérsités Vaudois (CHUV), Division de physiopathologie clinique, Lausanne, Switzerland.
4
Hypertension Unit, Hospital 12 de Octubre, & Department of Public Health and Preventive Medicine, Universidad Autónoma, Madrid, Spain.

Abstract

Although the blood pressure (BP) of many patients can be controlled using standard combinations, treatment of hypertension frequently represents a clinical challenge to the primary care physician. This article will review best practices for managing patients with easy- and difficult-to-treat hypertension, including preferred antihypertensive combinations, optimizing adherence and persistence, recognizing white-coat hypertension, and intensifying therapy for treatment-resistant patients. Each physician must decide based on his or her own level of experience at what point a patient becomes too challenging and would benefit from referral to a hypertension specialist for more intensive management and to complete the exclusion of secondary forms of arterial hypertension. With intensive pharmacotherapy, many patients with difficult-to-treat hypertension can achieve BP control. If it fails, interventional strategies (e.g., renal denervation) are a valid option to get BP controlled.

KEYWORDS:

Hypertension; Renal denervation; Treatment algorithm

PMID:
24456885
DOI:
10.1016/j.ijcard.2013.12.125
[Indexed for MEDLINE]
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